Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany.
J Surg Oncol. 2010 Apr 1;101(5):389-95. doi: 10.1002/jso.21498.
The placement of megaprostheses in patients with bone sarcoma is associated with high rates of infection, despite prophylactic antibiotic administration. In individual cases, secondary amputation is unavoidable in the effort to cure infection.
The infection rate in 51 patients with sarcoma (proximal femur, n = 22; proximal tibia, n = 29) who underwent placement of a silver-coated megaprosthesis was assessed prospectively over a 5-year period, along with the treatment administered for infection. The infection rate was compared with the data for 74 patients in whom an uncoated titanium megaprosthesis (proximal femur, n = 33; proximal tibia, n = 41) was implanted.
The infection rate was substantially reduced from 17.6% in the titanium to 5.9% in the silver group. Whereas 38.5% of patients in the titanium group ultimately had to undergo amputation when periprosthetic infection developed, these mutilating surgical procedures were not necessary in the study group.
The use of silver-coated prostheses reduced the infection rate in the medium term. In addition, less aggressive treatment of infection was possible in the group with silver-coated prostheses. Further studies with longer term follow-up periods and larger numbers of patients are warranted in order to confirm these encouraging results.
尽管使用了预防性抗生素，在骨肉瘤患者中植入大型假体仍会导致高感染率。在某些情况下，为了治愈感染，二次截肢是不可避免的。
前瞻性评估了 51 名接受银涂层大型假体植入术的肉瘤患者（股骨近端 n = 22；胫骨近端 n = 29）的感染率，并对感染的治疗情况进行了评估。将感染率与 74 名接受未涂层钛合金大型假体植入术的患者（股骨近端 n = 33；胫骨近端 n = 41）的数据进行了比较。
与钛合金组的 17.6%相比，银组的感染率显著降低（5.9%）。在钛合金组中，当发生假体周围感染时，38.5%的患者最终不得不进行截肢，而在研究组中，这些破坏性的手术是不必要的。
使用银涂层假体可降低中期感染率。此外，在使用银涂层假体的患者中，可以采取更具侵略性的感染治疗方法。为了证实这些令人鼓舞的结果，需要进行进一步的研究，包括更长时间的随访和更多的患者数量。
