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目的探讨二期翻修术治疗膝关节肿瘤型人工关节感染的疗效。方法 2003年8月-2010年8月,收治22例保肢术后膝关节肿瘤型人工关节感染患者。男11例,女11例;年龄15～55岁,平均29.6岁。其中20例为初次关节置换术后感染,2例为翻修术后;术后15 d～89个月发生感染。感染按照Coventry和Fitzgerald等人工关节感染分型标准:Ⅰ型3例,Ⅱ型15例,Ⅲ型4例。发生感染至该次入院时间为5～47个月,平均10.2个月。细菌培养提示阳性9例,阴性13例。2例出现发热,白细胞计数升高。一期清创术取出假体,临时骨水泥填充旷置;待感染控制后行二期翻修。结果一期清创术前C反应蛋白及红细胞沉降率均明显高于二期翻修术前,差异有统计学意义(P<0.05)。术后患者均获随访,随访时间5～63个月,平均23.6个月。一期清创术后18例(81.8%)感染控制,其中1例拒绝二期翻修,17例行二期翻修术;17例中1例因术后5个月感染复发,行截肢术。4例(18.2%)感染未控制,行截肢术。保肢率为77.3%(17/22)。1例肾癌骨转移患者因原发病于术后1年6个月死亡。末次随访时16例关节功能采用美国骨与软组织肿瘤学会功能评分(MSTS 93)为(69.4±12.7)分。结论肿瘤型人工关节重建后感染,应根据情况及时行二期翻修手术,可获得较好疗效。
Objective To investigate the effect of two-stage revision on knee joint type artificial joint infection. Methods From August 2003 to August 2010, 22 patients with knee joint type of artificial joint infection after limb salvage were treated. 11 males and 11 females; aged 15 to 55 years, mean 29.6 years old. Among them, 20 cases were infected after initial joint replacement and 2 cases were reconstructed. The infection occurred 15 days to 89 months after operation. Infection According to Coventry and Fitzgerald and other sub-type joint infection criteria: type Ⅰ in 3 cases, type Ⅱ in 15 cases, type Ⅲ in 4 cases. Infection occurred to the time of admission for 5 to 47 months, an average of 10.2 months. Bacterial culture tips positive in 9 cases, negative in 13 cases. 2 cases of fever, white blood cell count increased. A debridement removed the prosthesis, temporary bone cement filled exclusion; pending infection control line two renovations. Results The level of C-reactive protein and erythrocyte sedimentation rate before debridement was significantly higher than that before second revision (P <0.05). Patients were followed up for 5 to 63 months with an average of 23.6 months. 18 cases (81.8%) were infected with infection in one stage of debridement. One case rejected the second revision and the second revision was performed in 17 cases. One case of 17 cases was relapsed after infection for 5 months, and amputation was performed. Four cases (18.2%) were uncontrolled and underwent amputation. The limb salvage rate was 77.3% (17/22). One patient with renal cell carcinoma who had bone metastases died from the primary disease one year and six months after operation. At the last follow-up, 16 cases of joint function were evaluated by American Society of Bone and Soft Tissue Cancer (MSTS 93) score of (69.4 ± 12.7). Conclusion Tumor-type artificial joint reconstruction after infection, should be promptly underwent two revision surgery, get better curative effect.