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Title: [Ilizarov TECHNIQUE FOR TREATMENT OF INFECTION AFTER LIMB SALVAGE OPERATION OF PRIMARY BONE TUMOR].
Author: Wang L, Wu X, Wang S, Shi Y.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2016 Dec 08; 30(12):1452-1456. PubMed ID: 29786332.
Abstract:
OBJECTIVE: To investigate the application value of the Ilizarov technique for infection after the limb salvage operation of primary bone tumor. METHODS: A retrospective analysis was made on the clinical data of 6 patients with infection treated with Ilizarov technique after limb salvage operation of primary bone tumor between July 2012 and April 2015. There were 4 males and 2 females, aged 18-40 years (mean, 28 years). Tumor types included 3 cases of osteosarcoma and 3 cases of giant cell tumor of bone. Tumor located at the left distal femur in 2 cases, at the right distal femur in 1 case, at the left proximal tibia in 1 case, and at the right proximal tibia in 2 cases. Six cases had recurring infection after debridement. The patients underwent operation 2 to 5 times (mean, 3.5 times). The time from tumor resection to visiting was 8-20 months (mean, 14.3 months). During operation, the internal implant was removed; infection and necrotic tissue was removed thoroughly; and the Ilizarov external fixator was installed. After operation, gentamycin normal saline was used for 2 to 3 weeks, and the sensitive antibiotic intravenous infusion was performed at the same time. After 1 week, the osteotomy lengthening was used. RESULTS: All 6 patients were followed up for 6 to 18 months (mean, 12.2 months). Pin tract infection occurred in 1 case after operation; primary healing of incision was obtained in the other patients, and no related complications occurred. The external fixation time ranged from 6 to 16 months (mean, 11.5 months). The healing indexes ranged from 34 to 62 days/cm (mean, 52.0 days/cm). After removal of the external fixator, the knee range of motion ranged from 0 to 5° (mean, 3°) in extension, and from 120 to 130° (mean, 125°) in flexion. The American musculo-skeletal tumor society system (MSTS) function scoring was excellent in 3 patients, good in 2 patients, and fair in 1 patient, with an excellent and good rate of 83.3%. During follow-up period, there was no recurrence of infection; and no recurrence or metastasis was found in 3 patients with osteosarcoma. CONCLUSIONS: Infection can be cured by Ilizarov technique after limb salvage operation of bone tumor. 目的: 探讨应用Ilizarov技术治疗原发性骨肿瘤保肢术后感染的临床效果。. 方法: 回顾分析2012年7月-2015年4月，应用Ilizarov技术治疗6例原发性骨肿瘤保肢术后感染患者临床资料。男4例，女2例；年龄18～40岁，平均28岁。肿瘤类型：骨肉瘤3例，骨巨细胞瘤3例。肿瘤部位：左侧股骨远端2例，右侧股骨远端1例，左侧胫骨近端1例，右侧胫骨近端2例。6例感染后均行清创术并感染复发。该次就诊前患者共接受手术2～5次，平均3.5次。肿瘤切除术距离该次就诊时间为8～20个月，平均14.3个月。术中取出内植物，彻底清除感染及坏死组织，截骨并安装Ilizarov外固定支架。术后采用庆大霉素生理盐水持续灌洗2～3周，同时静脉滴注敏感抗生素；1周后开始截骨部位延长。. 结果: 6例患者术后均获随访，随访时间6～18个月，平均12.2个月。1例术后出现针道感染；其余患者切口均Ⅰ期愈合，无相关并发症发生。佩戴外固定支架时间6～16个月，平均11.5个月。骨愈合指数34～62 d/cm，平均52.0 d/cm。6例拆除外固定支架后膝关节活动范围伸直达0～5°，平均3°；屈曲120～130°，平均125°。末次随访时，参照1993年美国骨肿瘤学会（MSTS）评分系统，获优3例，良2例，中1例，优良率83.3%。随访期间感染均未复发；3例骨肉瘤患者无复发或转移。. 结论: Ilizarov技术治疗原发性骨肿瘤保肢术后感染可获得较好疗效。.

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