Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
Section for Medical Statistics, Medical University of Vienna, Vienna, Austria.
PLoS One. 2018 Jul 5;13(7):e0200304. doi: 10.1371/journal.pone.0200304. eCollection 2018.
The incidence of recurrent infections in patients following one or two stage revision for infected megaprostheses after resection of bone tumours was investigated. The difference between retaining at least one well fixed stem and a complete removal of the megaprosthesis during a two stage revision was also analysed.
627 patients who experienced a replacement of a musculoskeletal tumour by megaprostheses were recorded. An infection occurred in 83 of 621 patients available for follow-up. 61 patients underwent one stage revision, and 16 patients two stage revision for the first revision surgery. In the entire study period, two stage revision was performed 32 times (first, second, and third revision).
The cumulative incidence analysis showed a reinfection probability after one stage revision of 18% at one year, 30% at two years, 39% at five years, 46% at ten years, and 56% at 15 years. After two stage revision, a reinfection probability of 28% at two years, and 48% at five years was calculated. Cumulative incidence curves did not differ significantly (Gray's test; p = 0.51) between one and two stage revision (with and without complete removal of the stems). In two stage revision (n = 32), a statistically significant difference in infection rates between patients treated with complete removal of the megaprosthesis (n = 18) including anchorage stems and patients with at least one retained stem (n = 14) was shown (Fisher's exact test, p = 0.029).
Two stage revisions with complete removal of the megaprosthesis showed the best results among limb salvage procedures for the treatment of infected megaprosthesis.
研究切除骨肿瘤后一期或二期翻修感染型假体后患者复发性感染的发生率。还分析了在二期翻修时保留至少一个固定良好的假体和完全去除假体之间的差异。
记录了 627 名接受假体置换治疗骨肿瘤的患者。621 名可随访的患者中有 83 名发生感染。61 名患者接受一期翻修，16 名患者接受二期翻修作为首次翻修手术。在整个研究期间，二期翻修共进行了 32 次（第一次、第二次和第三次翻修）。
累积发病率分析显示，一期翻修后 1 年、2 年、5 年、10 年和 15 年的再感染概率分别为 18%、30%、39%、46%和 56%。二期翻修后，计算出两年内再感染的概率为 28%，五年内为 48%。（格雷氏检验；p=0.51），一期和二期翻修（有和没有完全去除假体）之间的累积发病率曲线无显著差异。在二期翻修（n=32）中，完全去除假体（n=18）包括锚固假体和至少保留一个假体的患者（n=14）之间的感染率存在统计学显著差异（Fisher 确切检验，p=0.029）。
对于感染型假体的治疗，完全去除假体的二期翻修是保肢手术中效果最好的方法。
