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.	伍衛剛, 鄭啟新, 郭曉東. 利福平-異煙肼-控釋型載藥人工骨的實驗研究. 中國生物醫學工程學報, 2010, 29(1):137-143.
3.	秦世炳, 董偉杰, 范俊, 等. 醫用硫酸鈣顆粒在骨關節結核治療中的應用探討. 結核病與胸部腫瘤, 2006, (2):103-106.
4.	秦世炳, 蘭汀隆, 范俊, 等. 醫用含利福平的 CaSO4 顆粒在骨關節結核治療中的應用. 北京醫學, 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.	蔣學遠, 王大偉.骨科臨床評價標準. 北京:人民衛生出版社, 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.	姜廣擎, 陳凱, 柳盛春,等. 骶髂關節結核的手術入路選擇. 中國誤診學雜志, 2006, 6(2):293.
9.	時述山, 胥少汀, 季新民, 等. 骶髂關節結核手術入路比較. 中華外科雜志, 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.	張聞力, 劉浩, 李壇珠, 等. 醫用硫酸鈣人工骨在脊柱結核手術中的應用. 中國矯形外科雜志, 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.	鄭先雨, 何家才. 醫用硫酸鈣 OsteoSet 修復頜骨缺損的療效評價. 中國修復重建外科雜志, 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.	李壇珠, 劉浩, 張聞力, 等. Osteoset 人工骨加自體骨移植治療胸腰椎脊柱結核:與自體骨移植的比較. 中國組織工程研究與臨床康復, 2008, 12(1):85-88.
20.	楊君禮, 袁牧, 許剛, 等. 利福平粉劑在脊柱結核病灶清除術中的應用觀察. 頸腰痛雜志, 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. 伍衛剛, 鄭啟新, 郭曉東. 利福平-異煙肼-控釋型載藥人工骨的實驗研究. 中國生物醫學工程學報, 2010, 29(1):137-143.
3. 秦世炳, 董偉杰, 范俊, 等. 醫用硫酸鈣顆粒在骨關節結核治療中的應用探討. 結核病與胸部腫瘤, 2006, (2):103-106.
4. 秦世炳, 蘭汀隆, 范俊, 等. 醫用含利福平的 CaSO4 顆粒在骨關節結核治療中的應用. 北京醫學, 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. 蔣學遠, 王大偉.骨科臨床評價標準. 北京:人民衛生出版社, 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. 姜廣擎, 陳凱, 柳盛春,等. 骶髂關節結核的手術入路選擇. 中國誤診學雜志, 2006, 6(2):293.
9. 時述山, 胥少汀, 季新民, 等. 骶髂關節結核手術入路比較. 中華外科雜志, 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. 張聞力, 劉浩, 李壇珠, 等. 醫用硫酸鈣人工骨在脊柱結核手術中的應用. 中國矯形外科雜志, 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. 鄭先雨, 何家才. 醫用硫酸鈣 OsteoSet 修復頜骨缺損的療效評價. 中國修復重建外科雜志, 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. 李壇珠, 劉浩, 張聞力, 等. Osteoset 人工骨加自體骨移植治療胸腰椎脊柱結核:與自體骨移植的比較. 中國組織工程研究與臨床康復, 2008, 12(1):85-88.
20. 楊君禮, 袁牧, 許剛, 等. 利福平粉劑在脊柱結核病灶清除術中的應用觀察. 頸腰痛雜志, 2005, 26(4):272-273.

Chinese Journal of Reparative and Reconstructive Surgery

TREATING SACROILIAC JOINT TUBERCULOSIS WITH RIFAMPICIN-LOADED OsteoSet

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