【摘 要】 目的 探討二期翻修術(shù)治療膝關(guān)節(jié)腫瘤型人工關(guān)節(jié)感染的療效。 方法 2003年8月－2010年8月，收治22例保肢術(shù)后膝關(guān)節(jié)腫瘤型人工關(guān)節(jié)感染患者。男11例，女11例；年齡15～55歲，平均29.6歲。其中20例為初次關(guān)節(jié)置換術(shù)后感染，2例為翻修術(shù)后；術(shù)后15 d～89個(gè)月發(fā)生感染。感染按照Coventry和Fitzgerald 等人工關(guān)節(jié)感染分型標(biāo)準(zhǔn)：Ⅰ型3例，Ⅱ型15例，Ⅲ型4例。發(fā)生感染至該次入院時(shí)間為5～47個(gè)月，平均10.2個(gè)月。細(xì)菌培養(yǎng)提示陽(yáng)性9例，陰性13例。2例出現(xiàn)發(fā)熱，白細(xì)胞計(jì)數(shù)升高。一期清創(chuàng)術(shù)取出假體，臨時(shí)骨水泥填充曠置；待感染控制后行二期翻修。 結(jié)果 一期清創(chuàng)術(shù)前C反應(yīng)蛋白及紅細(xì)胞沉降率均明顯高于二期翻修術(shù)前，差異有統(tǒng)計(jì)學(xué)意義（P lt; 0.05）。術(shù)后患者均獲隨訪，隨訪時(shí)間5～63個(gè)月，平均23.6個(gè)月。一期清創(chuàng)術(shù)后18例（81.8%）感染控制，其中1例拒絕二期翻修，17例行二期翻修術(shù)；17例中1例因術(shù)后5個(gè)月感染復(fù)發(fā)，行截肢術(shù)。4例（18.2%）感染未控制，行截肢術(shù)。保肢率為77.3%（17/22）。1例腎癌骨轉(zhuǎn)移患者因原發(fā)病于術(shù)后1年6個(gè)月死亡。末次隨訪時(shí)16例關(guān)節(jié)功能采用美國(guó)骨與軟組織腫瘤學(xué)會(huì)功能評(píng)分（MSTS 93）為（69.4 ± 12.7）分。 結(jié)論 腫瘤型人工關(guān)節(jié)重建后感染，應(yīng)根據(jù)情況及時(shí)行二期翻修手術(shù)，可獲得較好療效。
引用本文： 姬濤,郭衛(wèi),楊榮利,湯小東. 二期翻修治療膝關(guān)節(jié)腫瘤型人工關(guān)節(jié)感染. 中國(guó)修復(fù)重建外科雜志, 2012, 26(1): 21-25. doi: 復(fù)制
| 1. | of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res, 2010, 468(11): 2885-2895. |
| 2. | treated for an orthopaedic oncological condition. J Bone Joint Surg (Am), 2005, 87(4): 842-849. |
| 3. | lower extremity tumor endoprostheses. J Arthroplasty, 2007, 22(6): 859-865. |
| 4. | total hip arthroplasty. J Bone Joint Surg (Am), 1977, 59(7): 847-855. |
| 5. | J Bone Joint Surg (Br), 1994, 76(2): 178-186. |
| 6. | endoprosthesis revision surgery in 64 patients. Clin Orthop Relat Res, 1999, (358): 64-74. |
| 7. | Knee, 2010, 17(6): 403-406. |
| 8. | treatment, and outcomes. Clin Orthop Relat Res, 2002, (403): 23-28. |
| 9. | bone allografts in infected hip arthroplasty. Two-stage revision results. J Bone Joint Surg (Br), 2005, 87(3): 314-319. |
| 10. | Curr Opin Infect Dis, 2006, 19(4): 349-356. |
| 11. | Shehadeh A, Noveau J, Malawer M, et al. Late complications and survival. |
| 12. | Jeys LM, Grimer RJ, Carter SR, et al. Periprosthetic infection in patients. |
| 13. | Hardes J, Gebert C, Schwappach A, et al. Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg, 2006, 126(5): 289-296. |
| 14. | Flint MN, Griffin AM, Bell RS, et al. Two-stage revision of infected uncemented. |
| 15. | Grimer RJ, Belthur M, Chandrasekar C, et al. Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop Relat Res, 2002, (395): 193-203. |
| 16. | Spangehl MJ, Hanssen AD. Management of the infected total knee replacement.Cur Opin Orthop, 2002, 13(1): 23-29. |
| 17. | Coventry MB. Treatment of infections occurring in total hip surgery. Orthop Clin North Am, 1975, 6(4): 991-1003. |
| 18. | Fitzgerald RH Jr, Nolan DR, Ilstrup DM, et al. Deep wound sepsis following. |
| 19. | Guo W, Ji T, Yang R, et al. Endoprosthetic replacement for primary tumours around the knee: experience from Peking University. J Bone Joint Surg (Br), 2008, 90(8): 1084-1089. |
| 20. | Gosheger G, Gebert C, Ahren H, et al. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res, 2006, (450): 164-171. |
| 21. | Sim IW, Tse LF, Ek ET, et al. Salvaging the limb salvage: management of complications following endoprosthetic reconstruction for tumors around the knee. Eur J Surg Oncol, 2007, 33(6): 796-802. |
| 22. | Capanna R, Morris HG, Campanacci D, et al. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. |
| 23. | Wirganowicz PZ, Eckardt JJ, Dorey FJ, et al. Etiology and results of tumor. |
| 24. | Macmull S, Bartlett W, Miles J, et al. Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability. |
| 25. | Morii T, Yabe H, Morioka H, et al. Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. J Orthop Sci, 2010, 15(3): 331-339. |
| 26. | Cierny G 3rd, DiPasquale D. Periprosthetic total joint infections: staging,. |
| 27. | Buttaro MA, Pusso R, Piccaluga F. Vancomycin-supplemented impacted. |
| 28. | Deirmengian C, Greenbaum J, Lotke PA, et al. Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty. J Arthroplasty, 2003, 18(7 Suppl 1): 22-26. |
| 29. | Trampuz A, Widmer A. Infections associated with orthopedic implants. |
| 30. | Soriano A, Garcia-Ramiro S, Mensa J. Management of prosthetic joint infection. Reviews in Medical Microbilogy, 2006, 17(2): 55-63. |
| 31. | Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect, 1999, 48: 111-122. |
- 1. of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res, 2010, 468(11): 2885-2895.
- 2. treated for an orthopaedic oncological condition. J Bone Joint Surg (Am), 2005, 87(4): 842-849.
- 3. lower extremity tumor endoprostheses. J Arthroplasty, 2007, 22(6): 859-865.
- 4. total hip arthroplasty. J Bone Joint Surg (Am), 1977, 59(7): 847-855.
- 5. J Bone Joint Surg (Br), 1994, 76(2): 178-186.
- 6. endoprosthesis revision surgery in 64 patients. Clin Orthop Relat Res, 1999, (358): 64-74.
- 7. Knee, 2010, 17(6): 403-406.
- 8. treatment, and outcomes. Clin Orthop Relat Res, 2002, (403): 23-28.
- 9. bone allografts in infected hip arthroplasty. Two-stage revision results. J Bone Joint Surg (Br), 2005, 87(3): 314-319.
- 10. Curr Opin Infect Dis, 2006, 19(4): 349-356.
- 11. Shehadeh A, Noveau J, Malawer M, et al. Late complications and survival.
- 12. Jeys LM, Grimer RJ, Carter SR, et al. Periprosthetic infection in patients.
- 13. Hardes J, Gebert C, Schwappach A, et al. Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg, 2006, 126(5): 289-296.
- 14. Flint MN, Griffin AM, Bell RS, et al. Two-stage revision of infected uncemented.
- 15. Grimer RJ, Belthur M, Chandrasekar C, et al. Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop Relat Res, 2002, (395): 193-203.
- 16. Spangehl MJ, Hanssen AD. Management of the infected total knee replacement.Cur Opin Orthop, 2002, 13(1): 23-29.
- 17. Coventry MB. Treatment of infections occurring in total hip surgery. Orthop Clin North Am, 1975, 6(4): 991-1003.
- 18. Fitzgerald RH Jr, Nolan DR, Ilstrup DM, et al. Deep wound sepsis following.
- 19. Guo W, Ji T, Yang R, et al. Endoprosthetic replacement for primary tumours around the knee: experience from Peking University. J Bone Joint Surg (Br), 2008, 90(8): 1084-1089.
- 20. Gosheger G, Gebert C, Ahren H, et al. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res, 2006, (450): 164-171.
- 21. Sim IW, Tse LF, Ek ET, et al. Salvaging the limb salvage: management of complications following endoprosthetic reconstruction for tumors around the knee. Eur J Surg Oncol, 2007, 33(6): 796-802.
- 22. Capanna R, Morris HG, Campanacci D, et al. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur.
- 23. Wirganowicz PZ, Eckardt JJ, Dorey FJ, et al. Etiology and results of tumor.
- 24. Macmull S, Bartlett W, Miles J, et al. Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability.
- 25. Morii T, Yabe H, Morioka H, et al. Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. J Orthop Sci, 2010, 15(3): 331-339.
- 26. Cierny G 3rd, DiPasquale D. Periprosthetic total joint infections: staging,.
- 27. Buttaro MA, Pusso R, Piccaluga F. Vancomycin-supplemented impacted.
- 28. Deirmengian C, Greenbaum J, Lotke PA, et al. Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty. J Arthroplasty, 2003, 18(7 Suppl 1): 22-26.
- 29. Trampuz A, Widmer A. Infections associated with orthopedic implants.
- 30. Soriano A, Garcia-Ramiro S, Mensa J. Management of prosthetic joint infection. Reviews in Medical Microbilogy, 2006, 17(2): 55-63.
- 31. Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect, 1999, 48: 111-122.