保留假体的序贯疗法治疗骨肿瘤保肢术后假体周围感染

Prosthesis-preserving sequential method for treatment of peripheral prosthesis infection after bone tumor limb salvage

目的探索应用保留假体的"多米诺"序贯疗法治疗骨肿瘤保肢术后假体周围感染的注意事项和临床疗效。方法收集并回顾性分析2016年1月至2020年1月共11例采用保留假体的序贯疗法治疗骨肿瘤保肢术后假体周围感染患者资料,其中男8例,女3例;年龄(51.82±15.57)岁(范围21~74岁)。股骨远端肿瘤膝假体6例,胫骨近端肿瘤膝假体2例,骨盆假体感染2例,股骨中段假体1例。术前8例发热,2例出现窦道。序贯疗法治疗失败定义为:感染复发。治疗方法为保留假体的清创灌洗同时全身联合局部应用药物敏感的抗生素,评估患者的血常规、C反应蛋白、红细胞沉降率等指标,手术部位X线及CT扫描,并进行国际骨肿瘤协会(Musculoskeletal Tumor Society,MSTS)评分。结果微生物培养阳性率72.7%(8/11),其中金黄色葡萄球菌2例,表皮葡萄球菌1例,耐甲氧西林表皮葡萄球菌1例,耐甲氧西林金黄色葡萄球菌1例,鲍曼不动杆菌2例,停乳链球菌(C群)1例。治疗前及治疗后末次随访时MSTS评分由(10.91±2.31)分提升至(20.73±3.52)分,差异有统计学意义(t=7.162,P<0.05)。3例序贯治疗感染控制失败,手术成功率72.7%(8/11),其中1例截肢,1例长期创面换药,1例改用抗生素骨水泥联合髓内钉反向双插技术控制感染。结论对临床感染症状短于1个月的骨肿瘤保肢术后假体周围感染,采用保留假体的"多米诺"序贯疗法治疗可取的较好的早中期临床疗效。

Objective To explore the curative effect of the"domino"sequential method with prosthesis preservation in the treatment of infection around the prosthesis after limb salvage surgery for bone tumors.Methods A retrospective analysis of 11 patients with peripheral prosthetic infections after limb salvage surgery with prosthesis preserving"domino"from January 2016 to January 2020 was retrospectively analyzed,including 8 males and 3 females;age 21-74 years old,with an average of 51.8 years old.There were 6 cases of knee prosthesis for distal femoral tumor,2 cases of proximal tibia knee prosthesis,2 cases of pelvic prosthesis infection,and 1 case of middle femoral prosthesis.Before the operation,8 cases had fever,and 2 cases had sinus.Sequential treatment failure is defined as:recurrence of infection.The treatment method is the debridement and lavage of the prosthesis and the systemic combined local application of drug-sensitive antibiotics to evaluate the patient's blood routine,C-reflective protein,erythrocyte sedimentation rate and other indicators,X-ray and CT of the surgical site,and the Musculoskeletal Tumor Society(MSTS)score.Results The positive rate of microorganism culture was 72.7%(8/11),including 2 cases of Staphylococcus aureus,1 case of Staphylococcus epidermidis,1 case of methicillin-resistant Staphylococcus epidermidis,1 case of methicillin-resistant Staphylococcus aureus,abalone There were 2 cases of Acinetobacter mannifolia and 1 case of Streptococcus degalactiae.The MSTS score before treatment and at the last follow-up after treatment increased from 10.91±2.31 points to 20.73±3.52 points,the difference was statistically significant(t=7.162,P<0.05).A total of 3 cases of sequential treatment failed to control infection,and the operation success rate was 72.7%(8/11).One case was amputation,one case was long-term replacement of wound dressing,and one case was switched to antibiotic bone cement combined with intramedullary nail reverse double insertion technique to control infection.Conclusion For bone tumors with clinical infection symptoms less than one month after limb salvage surgery,the use of prosthesis-preserving"domino"sequential method for treatment of prosthetic infections is desirable for early and mid-term clinical efficacy.