膝关节假体置换术后骨肿瘤患者假体感染的两阶段翻修术

Ji Tao, Guo Wei, Yang Rongli, Tang Xiaodong

Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, 100044, P R China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Jan;26(1):21-5.

OBJECTIVE

To evaluate the outcome of two-stage revision for prostheses infection in patients with bone tumor after knee prosthetic replacement.

METHODS

Between August 2003 and August 2010, 22 patients with prostheses infection, who underwent knee prosthetic replacement in limb salvage treatment because of bone tumor, received two-stage revision. There were 11 males and 11 females with an average age of 29.6 years (range, 15-55 years). Prosthetic infection occurred after primary replacement in 20 patients and after revision surgery in 2 patients from 15 days to 89 months after operation. According to Coventry and Fitzgerald classification, type I was found in 3 cases, type II in 15 cases, and type III in 4 cases. The time from infection to admission was 5-47 months (mean, 10.2 months). The results of bacterial culture were positive in 9 cases and negative in 13 cases. Two patients had fever and leukocytosis. In one-stage, the implants and infected tissue were removed, and an antibiotic cement spacer with an intramedullary nail was implanted. In two-stage, a new endoprosthesis was inserted after infection was controlled.

RESULTS

The C-reactive protein and erythrocyte sedimentation rate before one-stage debridement were significantly higher than those before two-stage revision (P < 0.05). All patients were followed up 5-63 months (mean, 23.6 months). Infection was controlled after one-stage debridement in 18 cases (81.8%); two-stage revision was performed in 17 cases, and 1 case refused to receive two-stage revision. Of 17 patients, 1 patient was amputated because of infection at 5 months after revision. Four patients (18.2%) underwent amputation because of failure to control infection after one-stage debridement. The limb salvage rate was 77.3% (17/22). One case of renal cell carcinoma with bone metastasis died of original disease after 1 year and 6 months of operation. The Musculoskeletal Tumor Society (MSTS 93) score was 69.4 +/- 12.7 at last follow-up.

CONCLUSION

Two-stage revision should be performed in time and it has good results in the treatment of prostheses infection in patients with bone sarcomas after knee prosthetic replacement.

目的

评估膝关节假体置换术后骨肿瘤患者假体感染二期翻修的疗效。

方法

2003年8月至2010年8月，22例因骨肿瘤行保肢治疗并接受膝关节假体置换后发生假体感染的患者接受了二期翻修。其中男性11例，女性11例，平均年龄29.6岁（15 - 55岁）。20例患者在初次置换后发生假体感染，2例患者在翻修手术后15天至89个月发生感染。根据考文垂（Coventry）和菲茨杰拉德（Fitzgerald）分类，I型3例，II型15例，III型4例。从感染到入院的时间为5 - 47个月（平均10.2个月）。细菌培养结果9例阳性，13例阴性。2例患者有发热和白细胞增多。一期手术时，取出植入物和感染组织，并植入带髓内钉的抗生素骨水泥间隔物。二期手术时，在感染得到控制后植入新的假体。

结果

一期清创术前的C反应蛋白和红细胞沉降率显著高于二期翻修术前（P < 0.05）。所有患者均获随访5 - 63个月（平均23.6个月）。18例（81.8%）患者一期清创后感染得到控制；17例行二期翻修，1例拒绝二期翻修。17例患者中，1例在翻修术后5个月因感染行截肢术。4例（18.2%）患者因一期清创后感染未能控制而行截肢术。保肢率为77.3%（17/22）。1例肾细胞癌骨转移患者术后1年6个月死于原发病。末次随访时肌肉骨骼肿瘤学会（MSTS 93）评分为69.4±12.7。