SURGICAL-TREATMENT OF CHRONIC HEMATOGENOU S OSTEOMYELITIS - 420 CASES

Introduction Chronic hematogenous osteomyelitis (C.H.O.) is still a sc ourge of the non-industrialized countries. The authors operated on 420 cases of C.H.O, in Algeria between 1968 and 1987. A computerized anal ysis of the results of the surgical treatment of these 420 cases was m ade in Brussels, Belgium, by two of the authors. The results of this c omputerized study are exposed. Material and methods 67.1 per cent of t he patients were male and 37.9 female. 68 per cent were operated befor e 16 y. of age. 381 lesions involved tubular bones: femur, tibia and h umerus were the most frequent locations. Only 4 per cent of the cases had never presented a suppuration. Cultures of Staphylococcus were pos itive in 82 per cent of the cases. Surgical procedure was classical - bone window opening, sequestrectomy and saucerisation - in 359 cases. Operation was limited to soft tissues in 22 cases and bone resection w as performed in 39 cases. Post-operative antibiotherapy was administre d for a period of 10 to 60 days according to the patients. Results Aft er the first operation with the classical procedure, results were sati sfactory in 72 per cent of the cases but ''healing'' was achieved in 9 5 per cent of the cases after 2, 3, 4 and up to 6 operations. After bo ne resection, the rate of permanent healing was of 100 per cent. Follo w-up was of more of 1 year (up to 22 y.) in 80 per cent of the cases. Discussion As far as classical procedure is concerned, a computerized analysis made according to 34 variables, led to the conclusions that t he following variables could have a positive influence upon the progno sis: surgical team's experience, young age of the patient at the time of operation, subacute onset of the disease, location on the humerus, diaphysis of long bones, membranous and short bones, small number of s inuses, sclero-geodic radiologic appearance of the lesions, thin perif ocal radiologic condensation, thin periosteal reaction, post-operative administration of two antibiotics. Excellent results of bone resectio n are pointed out but attention is drawn on the dangers of extending t he indications for resection to the tubular bones. Conclusion The auth ors conclude that improvement in the results of the surgical treatment of C.H.O. may only take place after improvement of the quality and du ration of chemotherapy: that is confirmed by the results of a clinical trial they organized on the role of post-operative administration of Amoxicilline + Clavulanic Acid for a period of 60 days after surgery: 44 patients, 2 lost to follow-up, 4 failures and 38 ''healings'' (90.5 per cent) at 2 years and more.