INFECTION IN BONE ALLOGRAFTS - INCIDENCE, NATURE, AND TREATMENT
INFECTION IN BONE ALLOGRAFTS - INCIDENCE, NATURE, AND TREATMENT
复制标题
DOI：
10.2106/00004623-198870030-00008
复制
发表时间：
1988-03-01
影响因子：
5.3
通讯作者：
MANKIN, HJ
中科院分区：
文献类型：
--
作者：
LORD, CF;GEBHARDT, MC;MANKIN, HJ
283例移植了大量同种异体骨的患者中，33例（11.7%）发生了感染。为了评估这种破坏性并发症的发生频率并确定合并症和易感因素，我们比较了感染和未感染患者的人口统计数据。平均年龄、移植物类型、手术解剖位置和肿瘤分期的比较没有显著差异。对82例股骨远端移植物患者亚组的多元回归分析显示，感染与更广泛的手术（更多的骨、软组织或皮肤丢失）或多次手术相关的因素之间存在相关性。接受同种异体移植物感染的患者中，约有30%没有与感染风险增加相关的合并症或易感因素。革兰氏阳性菌是最常见的感染原因，有12例感染（36%）是由表皮葡萄球菌引起的。6名患者有单一的革兰氏阴性菌群，9名患者有混合菌群。33例同种异体移植物感染患者的最终结果与所有患者和未感染患者的结果相比较差。27例感染同种异体移植物（82%）被认为是治疗失败，因为需要截肢或切除移植物来控制感染。在过去的八年里，我们通过移除移植物，使用间隔物或外固定物来暂时维持肢体的长度，静脉注射和口服抗生素，以及植入第二次同种异体移植物，我们已经能够挽救11名患者的肢体。这些病人中有9个获得了极好的治疗效果。
Of 283 patients who had a massive allograft of bone, an infection developed in thirty-three (11.7 per cent). To assess the frequency and identify the co-morbid and predisposing factors of this devastating complication, we compared demographic data for the infected and non-infected patients. Comparison of mean age, type of graft, anatomical site of the procedure, and stage of the tumor yielded no significant differences. Multiple-regression analysis of a subgroup of eighty-two patients who had a distal femoral graft showed a correlation between infection and factors that are associated with more extensive surgery (more loss of bone, soft tissue, or skin) or with multiple operations. Approximately 30 per cent of the patients who had an infected allograft had no co-morbid or predisposing factors that could be statistically correlated with an increased risk for infection. Gram-positive organisms were the most common cause of infection, with twelve infections (36 per cent) being due to Staphylococcus epidermidis. Six patients had a single gram-negative organism and nine had mixed flora. The final result in the thirty-three patients who had an infected allograft was poor compared with that of the over-all series and of the uninfected patients. Twenty-seven infected allografts (82 per cent) were considered to be failures of treatment because amputation of the limb or resection of the graft was required to control the infection. In the last eight years, we have been able to salvage the limb in eleven patients by removing the graft, using a spacer or an external fixator to temporarily maintain the length of the limb, administering antibiotics intravenously and orally, and implanting a second allograft. Nine of these patients have had an excellent or a good result.