四肢长管骨恶性肿瘤灭活再植术后感染

Infection in the malignent tumors of long bones by replantation of resected bone after devitalization

目的探讨四肢长管骨恶性肿瘤灭活再植术后感染原因和治疗方法。方法将灭活再植术６８例分为感染与非感染组，对患者年龄、性别、灭活类型、手术部位、肿瘤分期和治疗结果进行临床分析。结果两组病例在年龄、性别、肿瘤分期三方面无显著性差异（Ｐ＞０．０５），６例感染均发生在骨关节灭活型，５例在胫骨上端，１例在股骨远端，股骨与胫骨相比较，具有显著性差异（Ｐ＜０．０５）。此外，感染组的局部复发率、远处转移率及２年病死率均比非感染组高。感染的主要病原菌是Ｇ＋球菌，多为金葡菌。结论灭活再植术后感染主要发生在胫骨上端；为预防感染，手术时应常规将内侧腓肠肌移植于灭活骨周围，与近端关节囊和前侧间室的肌筋膜缝合。

Objective To study the cause and treatment of infection in the malignent tumors of extremities by replantation of resected bone after devitalization. Method 68 patients who had treatment after divitalization and replantation,were devided into the infected and non-infected group.Clinical comparision was done on the patients, age,sex, type of devitalization,anatomical site of the procedure,stage of tumor(Ⅰ to Ⅱ),and results of the treatment.Results The two groups of patients did not differ significantly with regard to age,sex,stage of tumor( P >0.05),6 cases had infection in bone joints devicalization 5 in the proximal end of the tibia,1 in the distal end of the femur.There was significant difference between the femur and the tibia by chi-square testing( P <0.05).In addition,the incidence of the local recurrence,matastases,and death of two years in the infected groups was higher than that of the non-infected group. The main organisms which caused infection were gram-postive staphylococcus. Conclusion Infection after devitalization and replantation was common in the proximal end of the tibia.In order to prevent infection,when operation was carried out,the medial gastroc was routinely mobilized arround the devitalized bone and sutured proximally to the joint capsule and laterally to the fascia and muscles of the anterior compartment,the pesanseri muscles are then brought over to reinforce the reconstruction.