Scholarlink

Background <p>Determining the surgical extent of chronic osteomyelitis and fracture-related infection (FRI) remains challenging. Adequate resection margins prevent recurrence; however, no standardised preoperative tool objectively defines resection borders.</p> Objective <p>To compare PET‑CT–guided surgical planning versus the local standard‑of‑care imaging pathway (predominantly plain radiographs, with selective CT or MRI in a minority of patients) for chronic limb osteomyelitis and FRI outcomes.</p> Methods <p>Retrospective comparative cohort study of 126 patients treated 2019–2024. Group 1: 84 patients underwent 18&#xa0;F-FDG PET-CT imaging and map-based geographic debridement. Group 2: 42 patients received surgery after local standard‑of‑care imaging pathway (predominantly plain radiographs, with selective CT or MRI). Primary outcome: infection recurrence at 12 months. Multivariable logistic regression controlled for confounders.</p> Results <p>PET-CT group achieved 3.6% recurrence versus 16.7% in the conventional group (<i>p</i> = 0.011), representing 78.5% relative risk reduction and a number-needed-to-treat of 8. Critically, the PET-CT cohort had significantly worse baseline complexity: 3.3-fold longer infection duration (43.1 vs. 13.1 months, <i>p</i> &lt; 0.001) and 3.6-fold more prior surgeries (2.48 vs. 0.69, <i>p</i> &lt; 0.001). Multivariable analysis confirmed PET-CT-guided surgery as an independent protective factor (OR 0.19, 95% CI 0.05–0.72, <i>p</i> = 0.015). PET-CT drew the resection margins in all cases, soft-tissue collections in 23.8%, and sequestra in 67.9%.</p> Conclusions <p>In this retrospective comparative study, PET-CT may enable objective, adequate geographic debridement, bridging radical and conservative approaches. Superior outcomes despite treating more complex infections may support PET-CT as a preoperative planning modality, demonstrating potential clinical and cost-effectiveness benefits.</p> <p>(Therapeutic study – retrospective comparative cohort).</p> Level of evidence <p>III (Therapeutic study – retrospective comparative cohort).</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Is 18 F-FDG PET-CT-guided geographic debridement superior to conventional debridement in appendicular chronic osteomyelitis? a retrospective comparative cohort study

  • 期刊论文

  • 发表日期：

    2026年5月21日

查看全文
  • Ahmed Elsheikh,
  • Hussein Elseidy,
  • Hossam Saad

摘要

Background

Determining the surgical extent of chronic osteomyelitis and fracture-related infection (FRI) remains challenging. Adequate resection margins prevent recurrence; however, no standardised preoperative tool objectively defines resection borders.

Objective

To compare PET‑CT–guided surgical planning versus the local standard‑of‑care imaging pathway (predominantly plain radiographs, with selective CT or MRI in a minority of patients) for chronic limb osteomyelitis and FRI outcomes.

Methods

Retrospective comparative cohort study of 126 patients treated 2019–2024. Group 1: 84 patients underwent 18 F-FDG PET-CT imaging and map-based geographic debridement. Group 2: 42 patients received surgery after local standard‑of‑care imaging pathway (predominantly plain radiographs, with selective CT or MRI). Primary outcome: infection recurrence at 12 months. Multivariable logistic regression controlled for confounders.

Results

PET-CT group achieved 3.6% recurrence versus 16.7% in the conventional group (p = 0.011), representing 78.5% relative risk reduction and a number-needed-to-treat of 8. Critically, the PET-CT cohort had significantly worse baseline complexity: 3.3-fold longer infection duration (43.1 vs. 13.1 months, p < 0.001) and 3.6-fold more prior surgeries (2.48 vs. 0.69, p < 0.001). Multivariable analysis confirmed PET-CT-guided surgery as an independent protective factor (OR 0.19, 95% CI 0.05–0.72, p = 0.015). PET-CT drew the resection margins in all cases, soft-tissue collections in 23.8%, and sequestra in 67.9%.

Conclusions

In this retrospective comparative study, PET-CT may enable objective, adequate geographic debridement, bridging radical and conservative approaches. Superior outcomes despite treating more complex infections may support PET-CT as a preoperative planning modality, demonstrating potential clinical and cost-effectiveness benefits.

(Therapeutic study – retrospective comparative cohort).

Level of evidence

III (Therapeutic study – retrospective comparative cohort).