肿瘤型人工膝关节置换术后假体并发症的临床研究

Complications of tumor-type axial knee arthroplasty

目的探讨肿瘤型轴心式人工膝关节置换术后假体的并发症及处理方式。方法选择2011年1月至2018年12月在解放军联保部队第980(白求恩国际和平)医院接受肿瘤型轴心式人工膝关节假体置换的61例患者作为研究对象。纳入经病理组织学证实为下肢骨恶性肿瘤、具有良好的重建技术条件、在解放军联勤保障部队第980(白求恩国际和平)医院行肿瘤切除、肿瘤型轴心式人工膝关节假体置换术治疗并接受随访者。排除胫神经、腓总神经、腘动静脉受累或弥漫性皮肤浸润者、有远处转移,经全身化疗后仍无法达到广泛切除标准者、要求截肢与失访患者。采用卡方检验或Fisher精确分析不同临床特征患者3年并发症发生率,观察分析并发症发生原因和处理方式。结果61例患者术后3年内共9例患者发生并发症13例次,发生率15%。不同性别(P=0.462)、年龄(P=0.543)、肿瘤类型(P=0.119)、Enneking分期(P=0.261)、肿瘤位置(P=0.139)、术前化疗(P=0.441)等因素并发症发生率差异均无统计学意义。2例假体松动患者中,1例行膝关节假体翻修术,1例未予处理。2例深部感染患者均保留假体清创手术联合术后抗生素持续冲洗2周。1例假体断裂患者行肿瘤假体翻修术。1例假体周围骨折患者行切开复位内固定术后痊愈。5例患者伤口不愈合,予以碘伏纱布伤口换药,3例患者刀口愈合,2例行局部清创后缝合并换药后痊愈;2例腓总神经损伤,术后1~2个月出现小腿和足部感觉减退和部分功能失能,对症处理后痊愈。结论肿瘤型轴心式人工膝关节置换术后假体的并发症发生率较低,临床可根据并发症的特点进行针对性防治。

Objective To explore the complications and management of the prosthesis after the axial knee arthroplasty.Methods From January 2011 to December 2018,61 patients who underwent tumor-type axial knee prosthesis replacement at the 980th Hospital(Bethune International Peace Hospital)of the PLA were selected as the research objects.Inclusion criteria:malignant tumors of the lower extremities confirmed by histopathology,good conditions for reconstruction techniques,the patients who were treated with tumor resection,tumor-type axial knee prosthesis replacement,and who received the follow-up.Exclusion criteria:tibial nerve,common peroneal nerve,popliteal artery and vein involvement,or diffusive skin infiltration,the patients with distant metastases,those who did not meet the criteria of extensive resection after systemic chemotherapy,requiring amputation or who was lost to follow-up.Chi-square test or Fisher exact test was performed to analyze the complication incidence in patients with different clinical characteristics in three years.Results A total of nine patients had complications in 61 patients within three years after surgery,with an incidence of 14.75%.There was no statistically significant difference in the incidence of complications between different genders(P=0.462),ages(P=0.543),tumor types(P=0.119),Enneking stage(P=0.261),tumor locations(P=0.139),preoperative chemotherapy(P=0.441)and other factors.Among the two patients with prosthesis loosening,,one patient underwent knee prosthesis revision,and one patient was not treated.Two patients with deep infection retained prosthetic debridement surgery combined with postoperative antibiotics for two weeks.One patient with prosthetic fractures underwent tumor prosthetic revision.One patient with periprosthetic fracture underwent open reduction and internal fixation.Among five cases of non-union,three patients healed following iodophor gauze dressing chang,two cases healed following local debridement and dressing change.Two cases encountered common peroneal nerve injury with calf and foot sensation hyperesthesia and partial dysfunction in postoperative one to two months,which were cured after symptomatic treatment.Conclusion The complication incidence of prosthesis after tumor-type axial knee arthroplasty is low,and the clinical prevention and treatment can base on the characteristics of complications.