大段异体骨关节移植术后感染

Postoperative Infection in Massive Bone Allograft

目的 :分析恶性肿瘤患者行异体骨关节移植术后感染的原因及处理方法。方法 :83例患者术后平均随访41.6个月。结果 :9例 ( 10 .8% )发生感染。皮瓣坏死、血肿形成、软组织覆盖薄弱使感染危险性增高 ;革兰氏阳性菌最常见。结论 :感染是保肢手术的严重并发症。妥善的局部处理及合理应用抗菌素是重要的预防措施。

Objective: To study on the reason of infection and management in patients with limb malignant tumor froated with allografting. Methods: From 1991～1998, of 83 patients who had a massive allograft of bone, an infection developed in 9(10.8%). The average follow up is 41.6 months. To identify the co morbid and predisposing factors of this complication, we compared demographic data for the infected and non infected patients. Results: The infection perhaps was attributable to the skin necrosis, hematoma, more extensive surgery(more loss of bone and soft tissue), the graft in the proximal of tibia. Gram positive organisms were the most common qerm of infection. 4 patients cured, 2 failure and 3 amputation. Conclusions: Postoperative infection is a devastating complication of limb salvage surgery. Delayed or uncontrollable infection often results in resection of the allograft or amputation of the limb. The frequency of infection may be reduced by selection of reasonable indication of operation, enough drains and antibiotics after operation and better soft tissue repairs.