Clinical study on treatment of chronic infection of foot and ankle with lower extremity ischemic diseases by tibial transverse transport combined with antibiotic embedded bone cement_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Dong ¹ ,  ZHANG Yonghong ¹ , HE Guoyu ¹ , ZHANG Xingdong ¹ , QIN Sihe ²

1. Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China;
2. Department of Orthopaedics, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China;

Corresponding author：

ZHANG Yonghong, Email: yhzhy@139.com

Keywords：

Tibial transverse transport; chronic infection of foot and ankle; diabetic foot; arteriosclerosis obliterans; thromboangiitis obliterans

DOI：

10.7507/1002-1892.202003098

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Objective To study the effectiveness of tibial transverse transport combined with the antibiotics embedded bone cement in the treatment of chronic infection of foot and ankle with lower extremity ischemic diseases.Methods A retrospective analysis was performed on 28 patients with ischemic diseases of lower extremities associated with chronic foot and ankle infection who were treated with tibial transverse transport combined with antibiotic bone cement between August 2015 and October 2019. There were 22 males and 6 females, with an average age of 65.6 years (range, 41-86 years). There were 25 cases of diabetic foot, 2 cases of arteriosclerosis obliterans, and 1 case of thromboangiitis obliterans. The course of infection ranged from 1 to 27 years, with an average of 14.9 years. The healing condition and time of foot and ankle in all patients were recorded and compared, and the Wagner grading and WIFi (W: lower extremity wound classification; I: ischemic classification; Fi: foot infection classification) grading were compared before and at last follow-up.Results The wound surface of 1 diabetic foot patient improved at 111 days after operation, without purulent secretion, and lost follow-up. The remaining 27 cases were followed up 5 to 21 months (mean, 8.4 months). There was no necrosis in the tibial osteotomy incision and the local flap. After operation, 21 cases showed needle reaction of external fixator, but the needle infection gradually improved after the corresponding treatment. Among the 24 patients with diabetic foot, 1 died of multiple organ failure due to pulmonary infection. Acute lower extremity vascular embolism occurred in 1 case, and the foot was amputated due to acute gangrene. In the remaining 22 cases, the wound healing time of foot and ankle was 2.5-11.0 months (mean, 4.6 months). At last follow-up, Wagner grading and WIFi grading of the patients were significantly improved when compared with those before operation (P<0.05). One patient with thromboangiitis obliterans had foot and ankle healing at 6 months after operation. Two patients with lower extremity arteriosclerosis obliterans had foot and ankle healing at 16 and 18 months after operation, respectively.Conclusion Tibial transverse transport combined with the antibiotics embedded bone cement is effective in treating chronic infection of foot and ankle with lower extremity ischemic diseases.

Citation： WANG Dong, ZHANG Yonghong, HE Guoyu, ZHANG Xingdong, QIN Sihe. Clinical study on treatment of chronic infection of foot and ankle with lower extremity ischemic diseases by tibial transverse transport combined with antibiotic embedded bone cement. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(8): 979-984. doi: 10.7507/1002-1892.202003098 Copy

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2.	刘晓毅, 祁光裕, 禄韶英, 等. 静脉动脉化治疗血栓闭塞性脉管炎 31 例. 陕西医学杂志, 2009, 38(5): 587-589.
3.	中国医疗保健国际交流促进会糖尿病足病分会. 中国糖尿病足诊治指南. 中华医学杂志, 2017, 97(4): 251-258.
4.	Apelqvist J, Bakker K, van Houtum WH, et al. International consensus and practical guidelines on the management and the prevention of the diabetic foot International Working Group on the Diabetic Foot. Diabetes Metab Res Rev, 2000, 16(Suppl 1): S84-92.
5.	Ferguson JY, Sutherland M, Pandit HG, et al. The rate of symptomatic venous thromboembolism in patients undergoing elective Ilizarov surgery and the cost of chemical prophylaxis. Bone Joint J, 2014, 96-B(3): 426-430.
6.	Atef A, El-Tantawy A. Management of open infected comminuted tibial fractures using Ilizarov concept. Eur J Orthop Surg Traumatol, 2014, 24(3): 403-408.
7.	中国糖尿病足细胞与介入治疗技术联盟, 中国介入医师分会介入医学与生物工程技术委员会. 糖尿病足介入综合诊治临床指南 (第五版). 介入放射学杂志, 2019, 28(3): 205-216.
8.	Arokiyaraj S, Vincent S, Saravanan M, et al. Green synthesis of silver nanoparticles using Rheum palmatum root extract and their antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa. Artif Cells Nanomed Biotechnol, 2017, 45(2): 372-379.
9.	Liu Y, Dulchavsky DS, Gao X, et al. Wound repair by bone marrow stromal cells through growth factor production. J Surg Res, 2006, 136(2): 336-341.
10.	Antonopoulos AS, Papanikolaou E, Vogiatzi G, et al. Anti-inflammatory agents in peripheral arterial disease. Curr Opin Pharmacol, 2018, 39: 1-8.
11.	张朝霞. SDF-1/CXCR-4 促进骨髓来源细胞参与脉络膜新生血管形成. 西安: 第四军医大学, 2009.
12.	连浩宇. 干细胞动员在胫骨横向搬移治疗重度糖尿病足机制中的作用研究. 南宁: 广西医科大学, 2019.
13.	欧栓机, 许长鹏, 李贵涛, 等. 胫骨横向骨搬移对血清血管生成相关因子表达的影响. 中国修复重建外科杂志, 2020, 34(1): 98-101.
14.	彭冰, 宋才渊, 金红婷, 等. 慢性骨髓炎的临床诊断与治疗. 中国骨伤, 2015, 28(9): 870-873.
15.	张永红, 秦泗河, 王栋, 等. 骨搬运治疗胫骨慢性骨髓炎, 是否需要加用抗生素骨水泥?. 中国矫形外科杂志, 2017, 25(4): 331-335.
16.	李军, 薛宝宝, 徐超, 等. 足踝部慢性骨髓炎的手术治疗策略. 现代生物医学进展, 2019, 19(10): 1894-1897, 1928.
17.	Wiewiorski M, Barg A, Hoerterer H, et al. Risk factors for wound complications in patients after elective orthopedic foot and ankle surgery. Foot Ankle Int, 2015, 36(5): 479-487.
18.	Frommelt L. Antibiotic choice in bone surgery-local therapy using antibiotic-loaded bone cement//Walenkamp G, ed. Local antibiotics in arthroplasty. State of the art from an interdisciplinary view. New York: Thieme Stuttgart, 2007: 59-64.
19.	Wahlig H, Dingeldein E, Buchholz HW, et al. Pharmacokinetic study of gentamicin-loaded cement in total hip replacements. Comparative effects of varying dosage. J Bone Joint Surg (Br), 1984, 66(2): 175-179.
20.	Lorian V, Atkinson B. Effect of serum on gram-positive cocci grown in the presence of penicillin. J Infect Dis, 1978, 138(6): 865-871.
21.	Atkinson BA, Lorian V. Antimicrobial agent susceptibility patterns of bacteria in hospitals from 1971 to 1982. J Clin Microbiol, 1984, 20(4): 791-796.
22.	种涛, 赵斌, 张中华, 等. 骨水泥在骨科手术中的应用及展望. 中国现代医生, 2018, 56(10): 159-163.
23.	Gouron R, Petit L, Boudot C, et al. Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique. J Tissue Eng Regen Med, 2017, 11(2): 382-389.
24.	Apelqvist J. The foot in perspective. Diabetes Metab Res Rev, 2008, 24(Suppl 1): S110-S115.
25.	陈品英, 付荣, 苏璇, 等. 血管再通方治疗血栓闭塞性脉管炎疗效研究. 河北中医药学报, 2018, 33(5): 24-26.
26.	李全成, 苏少飞, 张忠梅. 经皮腔内血管介入治疗老年下肢动脉硬化闭塞症的疗效及其影响因素分析. 中华老年心脑血管病杂志, 2019, 21(11): 1207-1208.
27.	王江宁, 高磊. 糖尿病足慢性创面治疗的新进展. 中国修复重建外科杂志, 2018, 32(7): 832-837.
28.	镇普祥. 横向骨搬移治疗重度糖尿病足疗效与血管再生现象研究. 南宁: 广西医科大学, 2019.

1. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: Part Ⅱ. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1989, (239): 263-285.
2. 刘晓毅, 祁光裕, 禄韶英, 等. 静脉动脉化治疗血栓闭塞性脉管炎 31 例. 陕西医学杂志, 2009, 38(5): 587-589.
3. 中国医疗保健国际交流促进会糖尿病足病分会. 中国糖尿病足诊治指南. 中华医学杂志, 2017, 97(4): 251-258.
4. Apelqvist J, Bakker K, van Houtum WH, et al. International consensus and practical guidelines on the management and the prevention of the diabetic foot International Working Group on the Diabetic Foot. Diabetes Metab Res Rev, 2000, 16(Suppl 1): S84-92.
5. Ferguson JY, Sutherland M, Pandit HG, et al. The rate of symptomatic venous thromboembolism in patients undergoing elective Ilizarov surgery and the cost of chemical prophylaxis. Bone Joint J, 2014, 96-B(3): 426-430.
6. Atef A, El-Tantawy A. Management of open infected comminuted tibial fractures using Ilizarov concept. Eur J Orthop Surg Traumatol, 2014, 24(3): 403-408.
7. 中国糖尿病足细胞与介入治疗技术联盟, 中国介入医师分会介入医学与生物工程技术委员会. 糖尿病足介入综合诊治临床指南 (第五版). 介入放射学杂志, 2019, 28(3): 205-216.
8. Arokiyaraj S, Vincent S, Saravanan M, et al. Green synthesis of silver nanoparticles using Rheum palmatum root extract and their antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa. Artif Cells Nanomed Biotechnol, 2017, 45(2): 372-379.
9. Liu Y, Dulchavsky DS, Gao X, et al. Wound repair by bone marrow stromal cells through growth factor production. J Surg Res, 2006, 136(2): 336-341.
10. Antonopoulos AS, Papanikolaou E, Vogiatzi G, et al. Anti-inflammatory agents in peripheral arterial disease. Curr Opin Pharmacol, 2018, 39: 1-8.
11. 张朝霞. SDF-1/CXCR-4 促进骨髓来源细胞参与脉络膜新生血管形成. 西安: 第四军医大学, 2009.
12. 连浩宇. 干细胞动员在胫骨横向搬移治疗重度糖尿病足机制中的作用研究. 南宁: 广西医科大学, 2019.
13. 欧栓机, 许长鹏, 李贵涛, 等. 胫骨横向骨搬移对血清血管生成相关因子表达的影响. 中国修复重建外科杂志, 2020, 34(1): 98-101.
14. 彭冰, 宋才渊, 金红婷, 等. 慢性骨髓炎的临床诊断与治疗. 中国骨伤, 2015, 28(9): 870-873.
15. 张永红, 秦泗河, 王栋, 等. 骨搬运治疗胫骨慢性骨髓炎, 是否需要加用抗生素骨水泥?. 中国矫形外科杂志, 2017, 25(4): 331-335.
16. 李军, 薛宝宝, 徐超, 等. 足踝部慢性骨髓炎的手术治疗策略. 现代生物医学进展, 2019, 19(10): 1894-1897, 1928.
17. Wiewiorski M, Barg A, Hoerterer H, et al. Risk factors for wound complications in patients after elective orthopedic foot and ankle surgery. Foot Ankle Int, 2015, 36(5): 479-487.
18. Frommelt L. Antibiotic choice in bone surgery-local therapy using antibiotic-loaded bone cement//Walenkamp G, ed. Local antibiotics in arthroplasty. State of the art from an interdisciplinary view. New York: Thieme Stuttgart, 2007: 59-64.
19. Wahlig H, Dingeldein E, Buchholz HW, et al. Pharmacokinetic study of gentamicin-loaded cement in total hip replacements. Comparative effects of varying dosage. J Bone Joint Surg (Br), 1984, 66(2): 175-179.
20. Lorian V, Atkinson B. Effect of serum on gram-positive cocci grown in the presence of penicillin. J Infect Dis, 1978, 138(6): 865-871.
21. Atkinson BA, Lorian V. Antimicrobial agent susceptibility patterns of bacteria in hospitals from 1971 to 1982. J Clin Microbiol, 1984, 20(4): 791-796.
22. 种涛, 赵斌, 张中华, 等. 骨水泥在骨科手术中的应用及展望. 中国现代医生, 2018, 56(10): 159-163.
23. Gouron R, Petit L, Boudot C, et al. Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique. J Tissue Eng Regen Med, 2017, 11(2): 382-389.
24. Apelqvist J. The foot in perspective. Diabetes Metab Res Rev, 2008, 24(Suppl 1): S110-S115.
25. 陈品英, 付荣, 苏璇, 等. 血管再通方治疗血栓闭塞性脉管炎疗效研究. 河北中医药学报, 2018, 33(5): 24-26.
26. 李全成, 苏少飞, 张忠梅. 经皮腔内血管介入治疗老年下肢动脉硬化闭塞症的疗效及其影响因素分析. 中华老年心脑血管病杂志, 2019, 21(11): 1207-1208.
27. 王江宁, 高磊. 糖尿病足慢性创面治疗的新进展. 中国修复重建外科杂志, 2018, 32(7): 832-837.
28. 镇普祥. 横向骨搬移治疗重度糖尿病足疗效与血管再生现象研究. 南宁: 广西医科大学, 2019.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical study on treatment of chronic infection of foot and ankle with lower extremity ischemic diseases by tibial transverse transport combined with antibiotic embedded bone cement

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