Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Clin Orthop Relat Res. 2011 Oct;469(10):2889-94. doi: 10.1007/s11999-011-1877-z. Epub 2011 May 12.
The incidence of perioperative infection after segmental tumor endoprosthetic replacement in previous reports varies from a high of 7.4% to a low of 2.6%. Appropriate antibiotic use for this group is unknown and controversial, whereas the relationship of antibiotic use and perioperative infection is unclear.
QUESTIONS/PURPOSES: We determined the incidence of perioperative infection in patients with osteosarcoma treated with segmental prosthetic replacement using a standard perioperative antibiotic regimen and the incidence of late infections and wound complications.
We retrospectively reviewed the records of 53 patients with osteosarcoma undergoing segmental prosthetic replacements from 1993 to 2008. There were 30 males and 23 females ranging from 10 to 78 years of age. All patients were given intraoperative antibiotics (intravenous cefazolin), continued for 3 days postoperatively and then given orally for 5 days. Patients who were allergic to penicillin or cefazolin were given vancomycin followed by clindamycin. A perioperative infection was defined as a deep infection within 2 months after prosthetic reconstruction. The minimum followup was 1 year (range, 1-15 years).
We identified one confirmed perioperative prosthetic infection (1/53; 1.9%) (Enterobacter cloacae and methicillin-resistant Staphylococcus) in a 78-year-old woman after proximal tibial replacement, gastrocnemius flap, and skin graft. Her infection was controlled with débridement, drainage, and intravenous antibiotics. Three patients had late infections, two of which were culture negative. Four patients had wound complications that required further surgery.
The antibiotic regimen we used is longer than that recommended for patients having routine total joint arthroplasty. Its appropriateness will require comparison with alternate regimens, including those of shorter duration.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
以往报道的节段性肿瘤假体置换术后围手术期感染发生率从 7.4%的高值到 2.6%的低值不等。对于这组患者，抗生素的使用尚不清楚且存在争议，而抗生素的使用与围手术期感染的关系也不明确。
问题/目的：我们使用标准的围手术期抗生素方案，确定了接受节段性假体置换治疗的骨肉瘤患者的围手术期感染发生率，以及晚期感染和伤口并发症的发生率。
我们回顾性分析了 1993 年至 2008 年期间接受节段性假体置换的 53 例骨肉瘤患者的病历。其中男 30 例，女 23 例，年龄 10 岁至 78 岁。所有患者均给予术中抗生素（静脉头孢唑啉），术后连续使用 3 天，然后口服 5 天。对青霉素或头孢唑啉过敏的患者给予万古霉素，随后给予克林霉素。围手术期感染定义为假体重建后 2 个月内深部感染。最低随访时间为 1 年（1 年至 15 年）。
我们发现 1 例 78 岁女性患者（1/53；1.9%）在接受胫骨近端置换、腓肠肌瓣和植皮后发生确认的围手术期假体感染（阴沟肠杆菌和耐甲氧西林金黄色葡萄球菌）。经清创、引流和静脉使用抗生素后，该患者的感染得到了控制。3 例患者发生晚期感染，其中 2 例培养结果为阴性。4 例患者发生伤口并发症，需要进一步手术。
我们使用的抗生素方案比常规全关节置换术患者推荐的方案时间更长。其适当性需要与替代方案进行比较，包括那些持续时间更短的方案。
IV 级，治疗性研究。详见作者指南，获取完整的证据水平描述。
