[Efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography-assisted navigation system in the debridement of chronic osteomyelitis of the extremities].

This study explored the feasibility of an optical navigation system based on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) data for treating chronic osteomyelitis of long bones of extremities, and a retrospective analysis was conducted on 7 patients with chronic osteomyelitis of long bones of extremities admitted to the Department of Orthopedic Surgery, PLA General Hospital, from May 2023 to May 2024. Of the patients, there were 6 males and 1 female with a mean age of (47.4±13.7) years, and the lesion sites involved 1 case in the femur, 3 cases in the tibia, and 3 cases in the humerus. All the patients received treatment with the combination of an optical navigation system based on preoperative imaging planning via 18F-FDG PET/CT, where in the first-stage surgery, the scope of bone and soft tissue infection was determined according to imaging results, precise debridement and antibiotic-loaded bone cement packing were completed under real-time intraoperative navigation guidance, direct wound suture was performed in 6 cases, and flap transplantation was conducted for repair in 1 case due to poor soft tissue conditions. The bacterial culture results showed 5 cases of Staphylococcus aureus, 1 case of Pseudomonas aeruginosa, and 1 case of Klebsiella pneumoniae. In the second-stage surgery, the navigation system was used to calculate the volume of bone defects, and bone reconstruction was implemented using the Masquelet technique combined with autologous bone grafting, with an average clinical healing time of (3.4±0.4) months; 12-month postoperative follow-up indicated that all patient scores were improved compared with preoperative values, specifically the Self-Rating Anxiety Scale (SAS) score, Activities of Daily Living (ADL) Scale score, Disabilities of the Arm, Shoulder and Hand (DASH) Scale score, Lower Extremity Functional Scale (LEFS) score, and visual analogue scale (VAS) of pain [(35.6±3.6) vs (49.4±3.9) points, (96.4±4.8) vs (53.6±11.8) points, (28.7±8.5) vs (60.3±7.0) points, (63.5±4.1) vs (20.8±4.8) points, (0.7±0.9) vs (5.6±1.1) points, all P<0.05]. In conclusion, the 18F-FDG PET/CT-based navigation system can achieve preoperative independent planning, intraoperative lesion debridement with real-time monitoring, and precise treatment of chronic osteomyelitis of long bones of extremities.