Abstract
Background: The classical surgical treatment for hematogenous osteomyelitis is debridement and drip drainage surgery, and in recent years, antibiotic bone cement placement surgery has gradually gained widespread use.
Method: Information on 129 Hematogenic osteomyelitis (HO) patients, 67 treated with bone cement placement surgery and 62 with drip drainage surgery, was collected from January 2015 to January 2023. Baseline data, osteomyelitis classification, and clinical regression were compared between the two groups, with a mean follow-up of 2 years.
Result: Bone cement placement surgery had a higher infection control rate than drip drainage surgery (94% vs. 82.3%, P<0.001), and the EuroQol five-dimensional questionnaire (EQ-5D-3L)effect value was higher (0.763±0.29 vs. 0.717±0.42, P = 0.192). The efficacy of drip drainage surgery for Acute Hematogenic Osteomyelitis (AHO) was greatly improved, and the overall infection control rate was increased from 82.3% to 93.1%, which was even slightly higher than that of bone cement placement surgery (P = 0.452); bone cement placement surgery had a higher rate of infection control in chronic patients (94.5% vs. 72.7%, P = 0.004) and was more effective in treating metaphyseal focal osteomyelitis (97.5% vs. 71.4%, P = 0.002). The use of calcium sulfate calcium phosphate complex (CS/CP) was superior to polymethylmethacrylate (PMMA) (100% vs. 88.69%, P<0.001).
Conclusion: Bone cement placement surgery is recommended for the treatment of HO; drip drainage surgery is only indicated for AHO with long marrow cavity lesions; and CS/CP bone cement is preferred to PMMA, which requires a second removal to achieve good results because failure to remove it predisposes to recurrence of osteomyelitis.