• 北京大學(xué)人民醫(yī)院骨與軟組織腫瘤治療中心（北京，100044）;

【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

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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. 1. of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res, 2010, 468(11): 2885-2895.
  2. 2. treated for an orthopaedic oncological condition. J Bone Joint Surg (Am), 2005, 87(4): 842-849.
  3. 3. lower extremity tumor endoprostheses. J Arthroplasty, 2007, 22(6): 859-865.
  4. 4. total hip arthroplasty. J Bone Joint Surg (Am), 1977, 59(7): 847-855.
  5. 5. J Bone Joint Surg (Br), 1994, 76(2): 178-186.
  6. 6. endoprosthesis revision surgery in 64 patients. Clin Orthop Relat Res, 1999, (358): 64-74.
  7. 7. Knee, 2010, 17(6): 403-406.
  8. 8. treatment, and outcomes. Clin Orthop Relat Res, 2002, (403): 23-28.
  9. 9. bone allografts in infected hip arthroplasty. Two-stage revision results. J Bone Joint Surg (Br), 2005, 87(3): 314-319.
  10. 10. Curr Opin Infect Dis, 2006, 19(4): 349-356.
  11. 11. Shehadeh A, Noveau J, Malawer M, et al. Late complications and survival.
  12. 12. Jeys LM, Grimer RJ, Carter SR, et al. Periprosthetic infection in patients.
  13. 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. 14. Flint MN, Griffin AM, Bell RS, et al. Two-stage revision of infected uncemented.
  15. 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. 16. Spangehl MJ, Hanssen AD. Management of the infected total knee replacement.Cur Opin Orthop, 2002, 13(1): 23-29.
  17. 17. Coventry MB. Treatment of infections occurring in total hip surgery. Orthop Clin North Am, 1975, 6(4): 991-1003.
  18. 18. Fitzgerald RH Jr, Nolan DR, Ilstrup DM, et al. Deep wound sepsis following.
  19. 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. 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. 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. 22. Capanna R, Morris HG, Campanacci D, et al. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur.
  23. 23. Wirganowicz PZ, Eckardt JJ, Dorey FJ, et al. Etiology and results of tumor.
  24. 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. 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. 26. Cierny G 3rd, DiPasquale D. Periprosthetic total joint infections: staging,.
  27. 27. Buttaro MA, Pusso R, Piccaluga F. Vancomycin-supplemented impacted.
  28. 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. 29. Trampuz A, Widmer A. Infections associated with orthopedic implants.
  30. 30. Soriano A, Garcia-Ramiro S, Mensa J. Management of prosthetic joint infection. Reviews in Medical Microbilogy, 2006, 17(2): 55-63.
  31. 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.