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[目的]分析肿瘤型膝关节假体置换术后近期再次手术的原因,评价不同原因对再手术的影响。[方法]回顾分析西京骨科医院骨与软组织肿瘤科2010年1月~2013年6月收治的167例肿瘤型膝关节假体置换术病历资料,其中男106例,女61例;年龄8~72岁,平均25.27岁。骨肿瘤部位:股骨下段95例,胫骨上段72例;骨肿瘤类型:骨肉瘤88例,骨巨细胞瘤67例,Ewing肉瘤6例,软骨肉瘤4例,恶性纤维组织细胞瘤2例。96例恶性肿瘤患者术后行至少一次化疗,化疗药物有顺铂、多柔比星、洛铂、异环磷酰胺、甲氨蝶呤等。假体类型:定制型新轴心式膝关节假体44例,定制型旋转铰链膝关节假体56例,可延长式股骨远端膝关节假体2例,组配式铰链膝关节假体65例。首次手术距再次手术时间4~55个月,平均35.6个月;首次手术时长80~275 min,平均178.58 min;首次手术术中失血量450~1 000 ml,平均681.67 ml;首次手术术后第1 d引流量90~270 ml,平均175.75 ml。[结果]167例病例中34例进行了再次手术,占20.36%。再次手术的原因有:术后假体周围感染14例,占8.38%;局部肿瘤复发9例,占5.39%;假体松动8例,占4.79%;假体断裂3例,占1.80%。72例胫骨近端病例中,既往手术中行腓肠肌肌瓣转移术的57例,术后发生假体周围感染2例,占3.51%;未行腓肠肌肌瓣转移术的15例,术后发生假体周围感染6例,占40.00%。34例行再次手术的病例中,定制型新轴心式膝关节假体10例,定制型旋转铰链膝关节假体14例,组配式铰链膝关节假体10例。通过x2检验,发现化疗病例和未化疗病例在感染发生率方面差异存在统计学意义(P=0.026);行腓肠肌肌瓣转移术病例与未行该术病例在感染发生率方面差异存在统计学意义(P<0.005)。通过t检验发现感染病例和非感染病例在既往手术时间、术中失血量及术后第1 d伤口引流量方面差异无统计学意义(P=0.457、P=0.339、P=0.385)。[结论]导致肿瘤型膝关节假体置换术后近期再次手术的主要原因是术后假体周围感染,而化疗的应用、软组织覆盖的缺失等与感染的发生有密切的关系。
[Objective] To analyze the reason of recent reoperation after tumor type knee prosthesis replacement and evaluate the influence of different reasons on reoperation. [Methods] A retrospective analysis was performed on the data of 167 cases of knee prosthesis replacement treated by X-ray Osteoporosis Hospital from January 2010 to June 2013, including 106 males and 61 females, aged from 8 to 72 The average age is 25.27 years old. Bone tumor: 95 cases of the lower femur and 72 cases of the upper tibia; bone tumor types: 88 cases of osteosarcoma, 67 cases of giant cell tumor of bone, 6 cases of Ewing’s sarcoma, 4 cases of chondrosarcoma and 2 cases of malignant fibrous histiocytoma. Ninety-six patients with malignant tumor underwent at least one chemotherapy after chemotherapy. Chemotherapy drugs were cisplatin, doxorubicin, looplatinum, ifosfamide and methotrexate. Prosthesis types: 44 new custom-made axial knee prostheses, 56 custom-made revolving hinge knee prostheses, 2 extendable distal femoral knee prostheses, and 2 combined articulated knee prostheses example. The first operation from reoperation time of 4 to 55 months, an average of 35.6 months; the first operation of 80 ~ 275 min, an average of 178.58 min; the first operation blood loss 450 ~ 1 000 ml, an average of 681.67 ml; 1 d drainage 90 ~ 270 ml, an average of 175.75 ml. [Results] Of the 167 cases, 34 cases underwent reoperation, accounting for 20.36%. The reasons for reoperation were as follows: 14 cases were infected around the prosthesis, accounting for 8.38%; 9 cases were local tumor recurrence, accounting for 5.39%; 8 cases were prosthetic loosening, accounting for 4.79%; 3 cases were prosthetic fracture, accounting for 1.80%. Of the 72 cases of proximal tibia, 57 cases had gastrocnemius muscle flap transfer in the past surgery, 2 cases had peripheral infection, accounting for 3.51%; 15 cases had no gastrocnemius muscle flap transfer, and postoperative prosthesis Peripheral infection in 6 cases, accounting for 40.00%. Of the 34 cases undergoing reoperation, 10 were custom-made new-axis knee prostheses, 14 were custom-made revolute hinge prostheses, and 10 were knee-joint prostheses. By x2 test, there was a significant difference in the incidence of infection between chemotherapy and non-chemotherapy (P = 0.026). There was a significant difference in the incidence of infection between gastrocnemius muscle flap transplantation and non-operation (P <0.005). There was no significant difference between the infected and noninfected cases in the previous operation time, intraoperative blood loss and wound drainage on the first day after operation by t-test (P = 0.457, P = 0.339, P = 0.385). [Conclusion] The main reason of the recent reoperation after the operation of tumor type knee prosthesis replacement is postoperative infection around the prosthesis. The application of chemotherapy and the loss of soft tissue coverage are closely related to the occurrence of infection.