PDF(Pubmed)
Abstract：
BACKGROUND: Chronic osteomyelitis is a debilitating bone infection, characterized by a persistent infection over months to years, poses diagnostic and therapeutic challenges due to its insidious nature and potential for severe bone and soft tissue destruction. This systematic review and meta-analysis aims to review the literature on the treatment of chronic osteomyelitis in long bones and assess cure rates in single versus two-stage surgery.
METHODS: Following the PRISMA guidelines and registered with PROSPERO (ID: CRD42021231237), this review included studies that reported on the management of chronic osteomyelitis in long bones using either a planned one-stage or two-stage surgical approach in adult patients. Databases searched included Medline, Embase, Web of Science, CINAHL, HMIC, and AMED, using keywords related to osteomyelitis, long bones, and surgical management. Eligibility criteria focused on adults with chronic osteomyelitis in long bones, with outcomes reported after a minimum follow-up of 12 months. The meta-analysis utilized the random-effects model to pool cure rates.
RESULTS: The analysis included 42 studies with a total of 1605 patients. The overall pooled cure rate was 91% (CI 95%) with no significant difference observed between single-stage and two-stage surgeries (X2 = 0.76, P > 0.05). Complications were reported in 26.6% of cases in single-stage procedures and 27.6% in two-stage procedures, with prolonged wound drainage noted as a common issue. Dead space management techniques varied across studies, with antibiotic-loaded calcium sulphate beads used in 30.4% of cases.
CONCLUSIONS: This meta-analysis reveals no significant difference in cure rates between single and two-stage surgical treatments for chronic osteomyelitis in long bones, supporting the efficacy of both approaches. The current treatment strategy should include a combination of debridement, dead space management using local and systematic antibiotics and soft tissue reconstruction if necessary.
METHODS: Following the PRISMA guidelines and registered with PROSPERO (ID: CRD42021231237), this review included studies that reported on the management of chronic osteomyelitis in long bones using either a planned one-stage or two-stage surgical approach in adult patients. Databases searched included Medline, Embase, Web of Science, CINAHL, HMIC, and AMED, using keywords related to osteomyelitis, long bones, and surgical management. Eligibility criteria focused on adults with chronic osteomyelitis in long bones, with outcomes reported after a minimum follow-up of 12 months. The meta-analysis utilized the random-effects model to pool cure rates.
RESULTS: The analysis included 42 studies with a total of 1605 patients. The overall pooled cure rate was 91% (CI 95%) with no significant difference observed between single-stage and two-stage surgeries (X2 = 0.76, P > 0.05). Complications were reported in 26.6% of cases in single-stage procedures and 27.6% in two-stage procedures, with prolonged wound drainage noted as a common issue. Dead space management techniques varied across studies, with antibiotic-loaded calcium sulphate beads used in 30.4% of cases.
CONCLUSIONS: This meta-analysis reveals no significant difference in cure rates between single and two-stage surgical treatments for chronic osteomyelitis in long bones, supporting the efficacy of both approaches. The current treatment strategy should include a combination of debridement, dead space management using local and systematic antibiotics and soft tissue reconstruction if necessary.
摘要：
背景：慢性骨髓炎是一种使人衰弱的骨感染，以持续感染数月至数年为特征，由于其阴险的性质以及严重的骨骼和软组织破坏的可能性，因此提出了诊断和治疗挑战。本系统综述和荟萃分析旨在回顾有关长骨慢性骨髓炎治疗的文献，并评估单阶段手术与两阶段手术的治愈率。
方法：遵循PRISMA指南并在PROSPERO（ID：CRD42021231237）注册，本综述纳入了报道在成人患者中采用计划的一期或二阶段手术方法治疗长骨慢性骨髓炎的研究.搜索的数据库包括Medline,Embase,WebofScience,CINAHL,HMIC,AMED,使用与骨髓炎相关的关键词，长骨,和手术管理。资格标准侧重于长骨慢性骨髓炎的成年人，在最少12个月的随访后报告结局.荟萃分析利用随机效应模型来汇集治愈率。
结果：分析包括42项研究，共1605例患者。整体合并治愈率为91%（CI95%），单阶段和两阶段手术间无显著差异（X2=0.76，P>0.05）。单阶段手术中有26.6％的病例报告并发症，两阶段手术中有27.6％的病例报告并发症，长时间的伤口引流被认为是一个常见问题。死空间管理技术因研究而异，在30.4%的病例中使用负载抗生素的硫酸钙珠。
结论：这项荟萃分析显示，长骨慢性骨髓炎的单阶段和两阶段手术治疗的治愈率没有显着差异，支持这两种方法的有效性。目前的治疗策略应包括清创术的组合，如有必要，使用局部和系统的抗生素和软组织重建的死腔管理。
方法：遵循PRISMA指南并在PROSPERO（ID：CRD42021231237）注册，本综述纳入了报道在成人患者中采用计划的一期或二阶段手术方法治疗长骨慢性骨髓炎的研究.搜索的数据库包括Medline,Embase,WebofScience,CINAHL,HMIC,AMED,使用与骨髓炎相关的关键词，长骨,和手术管理。资格标准侧重于长骨慢性骨髓炎的成年人，在最少12个月的随访后报告结局.荟萃分析利用随机效应模型来汇集治愈率。
结果：分析包括42项研究，共1605例患者。整体合并治愈率为91%（CI95%），单阶段和两阶段手术间无显著差异（X2=0.76，P>0.05）。单阶段手术中有26.6％的病例报告并发症，两阶段手术中有27.6％的病例报告并发症，长时间的伤口引流被认为是一个常见问题。死空间管理技术因研究而异，在30.4%的病例中使用负载抗生素的硫酸钙珠。
结论：这项荟萃分析显示，长骨慢性骨髓炎的单阶段和两阶段手术治疗的治愈率没有显着差异，支持这两种方法的有效性。目前的治疗策略应包括清创术的组合，如有必要，使用局部和系统的抗生素和软组织重建的死腔管理。
