骨肉瘤保肢术后感染的治疗和预后分析

Treatment of Deep Infection After Limb Salvage of Osteosarcoma Patients and Prognosis Analysis

【目的】比较骨肉瘤术后假体周围感染的不同手术方法的效果,研究假体周围感染对骨肉瘤患者预后的影响,探讨骨肉瘤保肢术后假体周围感染治疗方法的选择。【方法】回顾分析2003-2008年在我院就诊的骨肉瘤患者,记录患者个人和病情的各种信息,并随访患者,建立临床资料数据库。提取骨肉瘤保肢患者术后假体周围感染患者资料,比较清创灌洗、一期翻修、二期翻修和截肢等手术方法控制感染的效果。利用Kaplan-Meier生存分析感染对骨肉瘤整体预后的影响。【结果】2003-2008年共183例EnneckingⅡB期骨肉瘤患者在我院接受治疗,其中术后假体周围感染患者为17人(9.28%),其中股骨远端7例,胫骨近端5例,肱骨近端2例,骨盆3例。感染发生时间中位时间为术后8.9月(2.3-31.5月),细菌培养阳性率为70.6%,多数为葡萄球菌。共经历25次手术,14例感染得到控制,感染控制率为82.4%;3例患者截肢,保肢成功率为82.4%。不同手术方法感染控制率:清创灌洗术感染控制率为33.3%(3/9),一期翻修手术感染控制率为50%(1/2);最终采取二期翻修患者感染控制率为100%(7/7)。最终采取截肢患者感染控制率为100%(3/3);通过Kaplan-Meier生存分析感染和无感染患者的两年生存率分别为94%和85%,五年生存率分别为79%和55%(P=0.04)。【结论】从感染控制角度,二期翻修是治疗骨肉瘤术后假体感染有效方法;预后方面,术后感染患者的要好于术后无感染患者。骨肉瘤保肢术后假体周围感染的手术治疗方法和时机的选择需要考虑到感染对预后的影响。

[Objective] Comparing the results of different operations for infection of patients with osteosarcoma after limb salvage and studying the effect of deep infection on the prognosis.Discussing how to determine the optimal treatment.[Methods]We retrospectively reviewed the osteosarcoma patients registered in our hospital from January 2003 to December of 2008,information about the general condition and disease-related factors of each patients were recorded.The patients were followed up the and clinical database was established.Patients suffered from the deep infection around the prosthesis were included in the current study.Debridement and irrigation,one-stage revision,two-stage revision and amputation were used to treat infection.The results of different methods of treatment were compared and Kaplan-Meier survival analysis was used to determine the effect of infection on the prognosis of patients with osteosarcoma.[Results] From January 2003 to December of 2008,183 patients with osteosarcoma at Ennecking Ⅱ B were treated in our hospital,17 patients suffered from the deep infection after limb salvage.Among them,there were 7 patients with tumor in the distal femurs,5 patients in the proximal tibia,2 patients in the proximal humerus and 3 patients in the pelvis.The median interval from operation to infection is 8.9 months （range from 2.3 to 31.5 months）.70.6％ of the infected patients were positive for bacteria culture,most of them are staphylococcus.Totally 25 operations were performed and 14 patients with infection were successfully cured,which lead the control rate of 82.4％.Three patients underwent amputation,and the rate of limb salvage is 82.4％.Two patients chose the amputation directly and both were successfully cured.Cure rate for patients choosing debridement and irrigation was 33.3％ （3/9）.For the two patients choosing one-stage revision,the cure rate was 50％.For the seven patients who underwent two-stage revision and three patients underwent amputation,the infections were all controlled.According to Kaplan-Meier survival analysis,two-year survival of patients with and without infection were 94％ and 85％,five-year survival of patients with and without infection were 79％ and 55％ （P =0.04） respectively.[Conclusion] From the point of treatment of infection,two-stage revision was the best choice.For the aspect of prognosis,patients with infection had superior clinical outcome than the patient without infection.The effect of infection on the prognosis of the patients with osteosarcoma should be considered when the option of treatment was determined.