Wafa H, Grimer R J, Reddy K, Jeys L, Abudu A, Carter S R, Tillman R M
Glasgow Royal Infirmary, 84, Castle Street, Glasgow, G4 0SF, UK.
Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
Bone Joint J. 2015 Feb;97-B(2):252-7. doi: 10.1302/0301-620X.97B2.34554.
We conducted a case-control study to examine the merit of silver-coated tumour prostheses. We reviewed 85 patients with Agluna-treated (silver-coated) tumour implants treated between 2006 and 2011 and matched them with 85 control patients treated between 2001 and 2011 with identical, but uncoated, tumour prostheses. In all, 106 men and 64 women with a mean age of 42.2 years (18.4 to 90.4) were included in the study. There were 50 primary reconstructions (29.4%); 79 one-stage revisions (46.5%) and 41 two-stage revisions for infection (24.1%). The overall post-operative infection rate of the silver-coated group was 11.8% compared with 22.4% for the control group (p = 0.033, chi-square test). A total of seven of the ten infected prostheses in the silver-coated group were treated successfully with debridement, antibiotics, and implant retention compared with only six of the 19 patients (31.6%) in the control group (p = 0.048, chi-square test). Three patients in the silver-coated group (3.5%) and 13 controls (15.3%) had chronic periprosthetic infection (p = 0.009, chi-square test). The overall success rates in controlling infection by two-stage revision in the silver-coated group was 85% (17/20) compared with 57.1% (12/21) in the control group (p = 0.05, chi-square test). The Agluna-treated endoprostheses were associated with a lower rate of early periprosthetic infection. These silver-treated implants were particularly useful in two-stage revisions for infection and in those patients with incidental positive cultures at the time of implantation of the prosthesis. Debridement with antibiotic treatment and retention of the implant appeared to be more successful with silver-coated implants.
我们进行了一项病例对照研究，以检验镀银肿瘤假体的优点。我们回顾了2006年至2011年间接受Agluna治疗（镀银）肿瘤植入物的85例患者，并将他们与2001年至2011年间接受相同但未镀膜肿瘤假体治疗的85例对照患者进行匹配。该研究共纳入106名男性和64名女性，平均年龄为42.2岁（18.4至90.4岁）。有50例一期重建（29.4%）；79例一期翻修（46.5%）和41例因感染进行的二期翻修（24.1%）。镀银组的总体术后感染率为11.8%，而对照组为22.4%（p = 0.033，卡方检验）。镀银组10个感染假体中有7个通过清创、抗生素治疗和保留植入物成功治疗，而对照组19例患者中只有6例（31.6%）成功（p = 0.048，卡方检验）。镀银组3例患者（3.5%）和13例对照组患者（15.3%）发生慢性假体周围感染（p = 0.009，卡方检验）。镀银组通过二期翻修控制感染的总体成功率为85%（17/20），而对照组为57.1%（12/21）（p = 0.05，卡方检验）。Agluna治疗的内置假体与较低的早期假体周围感染率相关。这些镀银植入物在感染的二期翻修以及假体植入时偶然培养结果为阳性的患者中特别有用。用抗生素治疗进行清创并保留植入物似乎在镀银植入物中更成功。
