二期翻修治疗膝关节肿瘤型人工关节感染

目的探讨二期翻修术治疗膝关节肿瘤型人工关节感染的疗效。方法 2003年8月-2010年8月,收治22例保肢术后膝关节肿瘤型人工关节感染患者。男11例,女11例;年龄15～55岁,平均29.6岁。其中20例为初次关节置换术后感染,2例为翻修术后;术后15 d～89个月发生感染。感染按照Coventry和Fitzgerald等人工关节感染分型标准:Ⅰ型3例,Ⅱ型15例,Ⅲ型4例。发生感染至该次入院时间为5～47个月,平均10.2个月。细菌培养提示阳性9例,阴性13例。2例出现发热,白细胞计数升高。一期清创术取出假体,临时骨水泥填充旷置;待感染控制后行二期翻修。结果一期清创术前C反应蛋白及红细胞沉降率均明显高于二期翻修术前,差异有统计学意义(P<0.05)。术后患者均获随访,随访时间5～63个月,平均23.6个月。一期清创术后18例(81.8%)感染控制,其中1例拒绝二期翻修,17例行二期翻修术;17例中1例因术后5个月感染复发,行截肢术。4例(18.2%)感染未控制,行截肢术。保肢率为77.3%(17/22)。1例肾癌骨转移患者因原发病于术后1年6个月死亡。末次随访时16例关节功能采用美国骨与软组织肿瘤学会功能评分(MSTS 93)为(69.4±12.7)分。结论肿瘤型人工关节重建后感染,应根据情况及时行二期翻修手术,可获得较好疗效。

Two-stage revision for prostheses infection in patients with bone tumor after knee prosthetic replacement

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.