Hardes J, Gebert C, Schwappach A, Ahrens H, Streitburger A, Winkelmann W, Gosheger G
Department of Orthopedics, Westfaelische Wilhelms-Universitaet Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany.
Arch Orthop Trauma Surg. 2006 Jul;126(5):289-96. doi: 10.1007/s00402-005-0009-1. Epub 2006 Apr 21.
Infection associated with prosthesis used after tumor resection is a common and serious complication. The purpose of the current retrospective study was to describe the course of infection in patients with a tumor endoprosthesis and the determination of risk factors associated with failed limb salvage.
30 patients with an infection associated with a tumor endoprosthesis were investigated with regard to treatment strategies, number and type of revision operations, duration of hospital stay, determination of risk factors associated with failed limb salvage and final outcome.
Limb salvage related to the complication infection was achieved in 19 patients (63.3%). Two-stage reimplantation of an endoprosthesis was successful in 14 patients but subsequently failed in one patient. Out of 11 patients where limb salvage failed, an amputation was performed in 6 patients, a rotationplasty in 4, and stump lengthening procedure in 1 patient. A poor soft tissue condition was a significant (P<0.05) risk factor for failed limb salvage. No patient receiving chemotherapy with a poor soft tissue condition had limb salvage surgery. The mean number of revision operations per patients was 2.6. The mean duration of hospital stay was 68 days.
Infection associated with prosthesis is a serious complication and is involved with long hospitalization. Limb salvage failed mostly in the case of a poor soft tissue condition. In these cases repeated revision surgery should be avoided and ablative surgery recommended at an early stage. Rotationplasty is an alternative to amputation in the case of an infection of the proximal or distal part of the femur.
肿瘤切除术后使用的假体相关感染是一种常见且严重的并发症。本回顾性研究的目的是描述肿瘤内置假体患者的感染过程，并确定与保肢失败相关的危险因素。
对30例与肿瘤内置假体相关感染的患者进行了治疗策略、翻修手术的次数和类型、住院时间、保肢失败相关危险因素的确定以及最终结局的调查。
19例患者（63.3%）实现了与并发症感染相关的保肢。14例患者的假体二期再植入成功，但随后1例失败。在11例保肢失败的患者中，6例行截肢术，4例行旋转成形术，1例行残端延长术。软组织条件差是保肢失败的一个显著（P<0.05）危险因素。软组织条件差且接受化疗的患者均未行保肢手术。每位患者的平均翻修手术次数为2.6次。平均住院时间为68天。
假体相关感染是一种严重并发症，且与住院时间长有关。保肢失败大多发生在软组织条件差的情况下。在这些情况下，应避免反复翻修手术，建议早期行切除性手术。对于股骨近端或远端感染，旋转成形术是截肢的一种替代方法。
