TREATING SACROILIAC JOINT TUBERCULOSIS WITH RIFAMPICIN-LOADED OsteoSet_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LIShuo ¹ , LIUWei ¹ , ZHANGHelong ¹ , ZHAODawei ² , LIUFengsheng ¹ , WANGShuhong ³ , ZHAOFei ⁴

1. Department of Orthopedics, Chest Hospital of Hebei Province, Shijiazhuang Hebei, 050041, P. R. China;
2. Department of Thoracic Surgery, Chest Hospital of Hebei Province, Shijiazhuang Hebei, 050041, P. R. China;
3. Department of Clinical Laboratory, Hebei Province Institute of Science and Technology for Family Planning;
4. Department of Orthopedics, Ningjin County Hospital of Hebei Province;

Corresponding author：

LIShuo, Email: doclsh@163.com

Keywords：

Sacroiliac joint tuberculosis; Medical calcium sulfate; Rifampicin release system; Translational medicine

DOI：

10.7507/1002-1892.20150088

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Objective To assess the safety, feasibility, and effectiveness of medical calcium sulfate (OsteoSet) mixed with powder for injection of rifampicin after radical debridement in the treatment of sacroiliac joint tuberculosis. Methods A retrospective analysis was made on the clinical data from 27 patients with sacroiliac joint tuberculosis who underwent debridement surgery and local bone graft of OsteoSet artificial bone impregnated with powder for injection of rifampicin between August 2006 and August 2010. There were 10 males and 17 females with an average age of 35.2 years (range, 16-64 years). The mean disease duration was 7.5 months (range, 1.5-16 months). The left sacroiliac joint was involved in 16 cases, the right side in 10 cases, and both sides in 1 case; Of them, 18 cases had iliac fossa abscess and 6 cases of buttocks abscess. According to the classification system by Kim, there were 9 cases of type Ⅲ and 18 cases of type ⅠV. The preoperative Majeed score was 61.23±6.49, including good in 4 patients, general in 19 patients, and poor in 4 patients. Results All patients achieved wound healing by first intention; no complications of pelvic infection, peripheral nerve injury, and lower extremity deep vein thrombosis occurred. Twenty-six patients were followed up 16 months on average (range, 12-24 months). All the patients had normal sense and movement of both lower limbs; no perineum sensory disturbance was found. One case of multi-drug resistant had local recurrence at 3 months after operation, which was cured after adjusting anti-tuberculosis drugs, nutritional support, enhancing immunity with thymopentin, and second operation. Bone union was observed at 10.5 months on average (range, 9-12 months) in 25 patients, and clinical symptoms disappeared with no recurrence or complication, and they returned to previous work. The Majeed score at last follow-up was 92.31±3.36, showing significant difference when compared with preoperative score (t=-32.76, P=0.00). The results were excellent in 22 patients, good in 4 patients, and the excellent and good rate was 100%, showing significant follow-up was 92.31±3.36, showing significant difference when compared with preoperative score (t=-32.76, P=0.00). The results were excellent in 22 patients, good in 4 patients, and the excellent and good rate was 100%, showing significant difference compared with the preoperative one (χ²=31.93, P=0.00). Conclusion Bone graft interbody fusion surgery with rifampicin loaded OsteoSet is one of the effective methods to treat sacroiliac joint tuberculosis.

Citation： LIShuo, LIUWei, ZHANGHelong, ZHAODawei, LIUFengsheng, WANGShuhong, ZHAOFei. TREATING SACROILIAC JOINT TUBERCULOSIS WITH RIFAMPICIN-LOADED OsteoSet. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 406-411. doi: 10.7507/1002-1892.20150088 Copy

1.	Kim NH, Lee HM, Yoo JD, et al. Sacroiliac joint tuberculosis:Classification and treatment. Clin Orthop Relat Res, 1999, (358):215-222.
2.	伍卫刚, 郑启新, 郭晓东. 利福平-异烟肼-控释型载药人工骨的实验研究. 中国生物医学工程学报, 2010, 29(1):137-143.
3.	秦世炳, 董伟杰, 范俊, 等. 医用硫酸钙颗粒在骨关节结核治疗中的应用探讨. 结核病与胸部肿瘤, 2006, (2):103-106.
4.	秦世炳, 兰汀隆, 范俊, 等. 医用含利福平的 CaSO4 颗粒在骨关节结核治疗中的应用. 北京医学, 2012, 34(12):1041-1043.
5.	Cai X, Han K, Cong X, et al. The use of calcium sulfate impregnated with vancomycin in the treatment of open fractures of long bones:a preliminary study. Orthopedics, 2010, 33(3):152-157.
6.	蒋学远, 王大伟.骨科临床评价标准. 北京:人民卫生出版社, 2005:128-129.
7.	Bezer M, Kucukdurmaz F, Aydin N, et al. Tuberculous spondylitis of the lumbosacral region:long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion. J Spinal Disord Tech, 2005, 18(5):425-429.
8.	姜广擎, 陈凯, 柳盛春,等. 骶髂关节结核的手术入路选择. 中国误诊学杂志, 2006, 6(2):293.
9.	时述山, 胥少汀, 季新民, 等. 骶髂关节结核手术入路比较. 中华外科杂志, 1993, 31(11):660-662.
10.	Skaggs DL, Samuelson MA, Hale JM, et al. Complications of posterior iliac crest bone grafting in spine surgery in children. Spine (Phila Pa 1976), 2000, 25(18):2400-2402.
11.	张闻力, 刘浩, 李坛珠, 等. 医用硫酸钙人工骨在脊柱结核手术中的应用. 中国矫形外科杂志, 2007, 15(9):652-655.
12.	Watson JT. The use of an injectable bone graft substitute in tibial metaphyseal fractures. Orthopedics, 2004, 27(1 Suppl):s103-107.
13.	郑先雨, 何家才. 医用硫酸钙 OsteoSet 修复颌骨缺损的疗效评价. 中国修复重建外科杂志, 2012, 26(1):87-90.
14.	Borrelli J Jr, Prickett WD, Ricci WM. Treatment of nonunions and osseous defects with bone graft and calcium sulfate. Clin Orthop Relat Res, 2003, (411):245-254.
15.	Wilkins R, Kelly C. Use of biodegradable antibiotic beads in orthopaedic infections. J Bone Joint Surg (Br), 2005, 87(SUPP Ⅲ):304.
16.	Huang X, Huang Z, Li W. Highly efficient release of simvastatin from simvastatinloaded calcium sulphate scaffolds enhances segmental bone regeneration in rabbits. Mol Med Rep, 2014, 9(6):2152-2158.
17.	Intini G, Andreana S, Margarone JE 3rd, et al. Engineering a bioactive matrix by modifications of calcium sulfate. Tissue Eng, 2002, 8(6):997-1008.
18.	Bibbo C, Patel DV. The effect of demineralized bone matrix-calcium sulfate with vancomycin on calcaneal fracture healing and infection rates:a prospective study. Foot Ankle Int, 2006, 27(7):487-493.
19.	李坛珠, 刘浩, 张闻力, 等. Osteoset 人工骨加自体骨移植治疗胸腰椎脊柱结核:与自体骨移植的比较. 中国组织工程研究与临床康复, 2008, 12(1):85-88.
20.	杨君礼, 袁牧, 许刚, 等. 利福平粉剂在脊柱结核病灶清除术中的应用观察. 颈腰痛杂志, 2005, 26(4):272-273.

1. Kim NH, Lee HM, Yoo JD, et al. Sacroiliac joint tuberculosis:Classification and treatment. Clin Orthop Relat Res, 1999, (358):215-222.
2. 伍卫刚, 郑启新, 郭晓东. 利福平-异烟肼-控释型载药人工骨的实验研究. 中国生物医学工程学报, 2010, 29(1):137-143.
3. 秦世炳, 董伟杰, 范俊, 等. 医用硫酸钙颗粒在骨关节结核治疗中的应用探讨. 结核病与胸部肿瘤, 2006, (2):103-106.
4. 秦世炳, 兰汀隆, 范俊, 等. 医用含利福平的 CaSO4 颗粒在骨关节结核治疗中的应用. 北京医学, 2012, 34(12):1041-1043.
5. Cai X, Han K, Cong X, et al. The use of calcium sulfate impregnated with vancomycin in the treatment of open fractures of long bones:a preliminary study. Orthopedics, 2010, 33(3):152-157.
6. 蒋学远, 王大伟.骨科临床评价标准. 北京:人民卫生出版社, 2005:128-129.
7. Bezer M, Kucukdurmaz F, Aydin N, et al. Tuberculous spondylitis of the lumbosacral region:long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion. J Spinal Disord Tech, 2005, 18(5):425-429.
8. 姜广擎, 陈凯, 柳盛春,等. 骶髂关节结核的手术入路选择. 中国误诊学杂志, 2006, 6(2):293.
9. 时述山, 胥少汀, 季新民, 等. 骶髂关节结核手术入路比较. 中华外科杂志, 1993, 31(11):660-662.
10. Skaggs DL, Samuelson MA, Hale JM, et al. Complications of posterior iliac crest bone grafting in spine surgery in children. Spine (Phila Pa 1976), 2000, 25(18):2400-2402.
11. 张闻力, 刘浩, 李坛珠, 等. 医用硫酸钙人工骨在脊柱结核手术中的应用. 中国矫形外科杂志, 2007, 15(9):652-655.
12. Watson JT. The use of an injectable bone graft substitute in tibial metaphyseal fractures. Orthopedics, 2004, 27(1 Suppl):s103-107.
13. 郑先雨, 何家才. 医用硫酸钙 OsteoSet 修复颌骨缺损的疗效评价. 中国修复重建外科杂志, 2012, 26(1):87-90.
14. Borrelli J Jr, Prickett WD, Ricci WM. Treatment of nonunions and osseous defects with bone graft and calcium sulfate. Clin Orthop Relat Res, 2003, (411):245-254.
15. Wilkins R, Kelly C. Use of biodegradable antibiotic beads in orthopaedic infections. J Bone Joint Surg (Br), 2005, 87(SUPP Ⅲ):304.
16. Huang X, Huang Z, Li W. Highly efficient release of simvastatin from simvastatinloaded calcium sulphate scaffolds enhances segmental bone regeneration in rabbits. Mol Med Rep, 2014, 9(6):2152-2158.
17. Intini G, Andreana S, Margarone JE 3rd, et al. Engineering a bioactive matrix by modifications of calcium sulfate. Tissue Eng, 2002, 8(6):997-1008.
18. Bibbo C, Patel DV. The effect of demineralized bone matrix-calcium sulfate with vancomycin on calcaneal fracture healing and infection rates:a prospective study. Foot Ankle Int, 2006, 27(7):487-493.
19. 李坛珠, 刘浩, 张闻力, 等. Osteoset 人工骨加自体骨移植治疗胸腰椎脊柱结核:与自体骨移植的比较. 中国组织工程研究与临床康复, 2008, 12(1):85-88.
20. 杨君礼, 袁牧, 许刚, 等. 利福平粉剂在脊柱结核病灶清除术中的应用观察. 颈腰痛杂志, 2005, 26(4):272-273.

Chinese Journal of Reparative and Reconstructive Surgery

TREATING SACROILIAC JOINT TUBERCULOSIS WITH RIFAMPICIN-LOADED OsteoSet

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