摘要
[目的]观察表面涂布抗生素骨水泥的股骨远端肿瘤假体在股骨远端骨肿瘤保肢治疗中的抗感染效果并评价其在临床应用的可行性。[方法]2008年6月2012年6月,79例股骨远端骨肿瘤患者在本院行瘤段切除、定制轴心式骨肿瘤假体重建治疗,其中男性51例,女性28例;年龄1446岁(平均21岁),骨肿瘤类型包括骨肉瘤41例,骨巨细胞瘤15例,软骨肉瘤10例,Ewing肉瘤7例,恶性纤维组织细胞瘤4例,纤维肉瘤2例。根据Enneking原发恶性骨肿瘤分期,在64例原发恶性骨肿瘤当中,ⅠA 2例,ⅠB 2例,ⅡA 12例,ⅡB 48例。根据假体表面是否应用抗生素骨水泥涂层,将患者分为两组,即抗感染涂层组(36例)和无抗感染涂层组(43例),抗感染涂层设计为在聚乙烯套上打孔后术中进行抗生素(硫酸庆大霉素)骨水泥涂布。术后随访观察假体周围感染、肿瘤复发和远隔转移,并评价肢体功能情况。[结果]随访350个月(平均25个月),抗感染涂层组无假体周围感染发生,无抗感染涂层组术后5例出现深部感染,经统计学分析,两组假体感染率之间差异具有统计学意义(P<0.05)。在64例原发恶性骨肿瘤患者中,9例出现局部复发和远隔转移,其中抗感染涂层组局部复发2例,远隔转移2例;无抗感染涂层组局部复发3例,远隔转移2例。最近一次随访,MSTS93功能评分显示抗感染涂层组平均24.6分,无抗感染涂层组平均19.5分。随访期内抗感染涂层组未见假体聚乙烯套表层骨水泥脱落现象。[结论]采用聚乙烯套钻孔并涂布抗生素骨水泥于定制股骨远端肿瘤假体表面的技术能有效控制肿瘤假体重建后感染,该方法简单易行,值得临床推广。
[ Objective] To observe the effect of the distal femoral tumor prosthesis coated with antibiotic cement on infec- tion control during limb salvage treatment, and to evaluate its potential prospect in clinic. [ Methods ] From Jun 2008 to Jun 2012, the en bloc resection and reconstruction using the custom - made distal femoral replacement with a constrained knee ar- throplasty were performed in 79 patients with distal femoral primary bone tumor, which involved osteosarcoma (41), GCT ( 15), chondrosarcoma (10), Ewing sarcoma (7), MFH (4), fibrosarcoma (2) . According to Enneking staging classification, there were 2 cases in I A, 2 cases in I B, 12 cases inⅡ A, and 48 cases in ⅡB in 64 patients with primary malignant bone tumor. The patients were divided into two groups randomly, which included antibiotic cement coating group (36 cases) and no antibiotic cement coating group (43 cases) . The antibiotic cement with gentamicin sulfate was coated on surface of porous poly- ethylene suit during operation. The peri - prosthetic infection, local recurrence, distant metastasis and function were followed up. [ Results] Patients were followed up for 3 - 50 months ( average 25 months) . There was no peri - prosthesis infection in anti - infection coating group. Five cases showed deep infection in no anti - infection coating group. Significant statistics differences ex- isted between two group (P 〈 0. 05) . Local recurrence and distant metastasis happened in 9 of 64 patients with primary malig- nant bone tumor. Two cases of local recurrence and 2 cases of distant metastasis occurred in anti - infective coating group,whereas 3 cases of local recurrence and 2 cases of distant metastasis in control group. During recent follow - up, MSTS93 function scoring displayed 24. 6 in anti - infection coating group and 19. 5 in no anti - infection coating group. The radiography showed that the antibiotic cement had not broken and fallen off during the follow - up period. [ Conclusion ] The antibiotic ce-ment coated technique on the surface of the polyethylene suit of custom - made distal femoral prosthesis is simple and effective in controlling peri - prosthesis infection after tumor prosthesis reconstruction.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第9期887-892,共6页
Orthopedic Journal of China
关键词
骨肿瘤
假体
感染
抗生素骨水泥
bone tumor, prosthesis, infection, antibiotic cement