Ilizarov TECHNIQUE FOR TREATMENT OF INFECTION AFTER LIMB SALVAGE OPERATION OF PRIMARY BONE TUMOR_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGLin ^1,2 ,  WUXuejian ¹ , WANGShunli ² , SHIYingbin ²

1. Department of Traumatic Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P. R. China;
2. Department of Bone Tumor, Zhengzhou Orthopaedics Hospital;

Corresponding author：

WUXuejian, Email: wuxuejiande@126.com

Keywords：

Ilizarov technique; Bone tumor; Limb salvage operation; Infection; Complication

DOI：

10.7507/1002-1892.20160301

Video：

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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. Conclusion Infection can be cured by Ilizarov technique after limb salvage operation of bone tumor.

Citation： WANGLin, WUXuejian, WANGShunli, SHIYingbin. Ilizarov TECHNIQUE FOR TREATMENT OF INFECTION AFTER LIMB SALVAGE OPERATION OF PRIMARY BONE TUMOR. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(12): 1452-1456. doi: 10.7507/1002-1892.20160301 Copy

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2.	Çıraklı A, Dabak N, Çıraklı S, et al. Distribution of pediatric bone and soft tissue tumors in the central Black Sea region. Turk J Pediatr, 2014, 56(3):226-231.
3.	阎洪亮, 董扬.保留骨骺的保肢技术在治疗青少年膝关节周围骨肉瘤患者中的应用进展.中国骨与关节杂志, 2015, 4(5):408-410.
4.	于秀淳, 刘晓平, 李开华.恶性骨肿瘤保肢技术的最新进展.中华骨科杂志, 2000, 20(7):424-427.
5.	Kapoor SK, Thiyam R. Management of infection following reconstruction in bone tumors. J Clin Orthop Trauma, 2015, 6(4):244-251.
6.	Bumgardner JD, Adatrow P, Haggard WO, et al. Emerging antibacterial biomaterial strategies for the prevention of peri-implant inflammatory diseases. Int J Oral Maxillofac Implants, 2011, 26(3):553-560.
7.	Kundu ZS, Gogna P, Gupta V, et al. Ankle fusion with centralisation of the fibula after distal tibia bone tumour resection. J Orthop Traumatol, 2014, 15(2):95-101.
8.	唐辉, 沙勇, 李春晓, 等. Ilizarov技术结合髓腔开窗持续冲洗治疗下肢髓内钉所致慢性骨髓炎.中华创伤骨科杂志, 2015, 17(10):868-873.
9.	张彦龙, 彭阿钦, 吴希瑞.双平面截骨骨搬移治疗胫骨大段感染性骨缺损.中华创伤杂志, 2016, 32(7):638-644.
10.	El-Rosasy MA. Ilizarov treatment for pseudarthrosis of the tibia due to haematogenous osteomyelitis. J Pediatr Orthop B, 2013, 22(3):200-206.
11.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286):241-246.
12.	Graci C, Maccauro G, Muratori F, et al. Infection following bone tumor resection and reconstruction with tumoral prostheses:a literature review. Int J Immunopathol Pharmacol, 2010, 23(4):1005-1013.
13.	Hardes J, Henrichs MP, Gosheger G, et al. Endoprosthetic replacement after extra-articular resection of bone and soft-tissue tumours around the knee. Bone Joint J, 2013, 95-B (10):1425-1431.
14.	Windhager R, Leithner A, Hochegger M. Revision of tumour endoprostheses around the knee joint. Review and own results. Orthopade, 2006, 35(2):176-183.
15.	Ashfaq K, Fragomen AT, Nguyen JT, et al. Correction of proximal tibia varus with external fixation. J Knee Surg, 2012, 25(5):375-384.
16.	Tsuchiya H, Abdel-Wanis ME, Sakurakichi K, et al. Osteosarcoma around the knee. Intraepiphyseal excision and biological reconstruction with distraction osteogenesis. J Bone Joint Surg (Br), 2002, 84(8):1162-1166.
17.	唐辉, 沙勇, 李春晓, 等. Ilizarov技术结合髓腔开窗持续冲洗治疗下肢髓内钉所致慢性骨髓炎.中华创伤骨科杂志, 2015, 17(10):868-873.
18.	焦绍锋, 秦泗河, 王振军, 等. Ilizarov技术治疗四肢畸形并发症分析.中华骨科杂志, 2012, 32(3):245-248.
19.	成亮, 徐佳, 柴益民, 等.单边外固定支架与环形外固定支架骨搬运治疗下肢长干骨缺损的疗效及并发症比较.中华创伤骨科杂志, 2015, 17(10):863-867.

1. Dabak N, Cıraklı A, Gülman B, et al. Distribution and evaluation of bone and soft tissue tumors in the middle Black Sea Region. Acta Orthop Traumatol Turc, 2014, 48(1):17-24.
2. Çıraklı A, Dabak N, Çıraklı S, et al. Distribution of pediatric bone and soft tissue tumors in the central Black Sea region. Turk J Pediatr, 2014, 56(3):226-231.
3. 阎洪亮, 董扬.保留骨骺的保肢技术在治疗青少年膝关节周围骨肉瘤患者中的应用进展.中国骨与关节杂志, 2015, 4(5):408-410.
4. 于秀淳, 刘晓平, 李开华.恶性骨肿瘤保肢技术的最新进展.中华骨科杂志, 2000, 20(7):424-427.
5. Kapoor SK, Thiyam R. Management of infection following reconstruction in bone tumors. J Clin Orthop Trauma, 2015, 6(4):244-251.
6. Bumgardner JD, Adatrow P, Haggard WO, et al. Emerging antibacterial biomaterial strategies for the prevention of peri-implant inflammatory diseases. Int J Oral Maxillofac Implants, 2011, 26(3):553-560.
7. Kundu ZS, Gogna P, Gupta V, et al. Ankle fusion with centralisation of the fibula after distal tibia bone tumour resection. J Orthop Traumatol, 2014, 15(2):95-101.
8. 唐辉, 沙勇, 李春晓, 等. Ilizarov技术结合髓腔开窗持续冲洗治疗下肢髓内钉所致慢性骨髓炎.中华创伤骨科杂志, 2015, 17(10):868-873.
9. 张彦龙, 彭阿钦, 吴希瑞.双平面截骨骨搬移治疗胫骨大段感染性骨缺损.中华创伤杂志, 2016, 32(7):638-644.
10. El-Rosasy MA. Ilizarov treatment for pseudarthrosis of the tibia due to haematogenous osteomyelitis. J Pediatr Orthop B, 2013, 22(3):200-206.
11. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286):241-246.
12. Graci C, Maccauro G, Muratori F, et al. Infection following bone tumor resection and reconstruction with tumoral prostheses:a literature review. Int J Immunopathol Pharmacol, 2010, 23(4):1005-1013.
13. Hardes J, Henrichs MP, Gosheger G, et al. Endoprosthetic replacement after extra-articular resection of bone and soft-tissue tumours around the knee. Bone Joint J, 2013, 95-B (10):1425-1431.
14. Windhager R, Leithner A, Hochegger M. Revision of tumour endoprostheses around the knee joint. Review and own results. Orthopade, 2006, 35(2):176-183.
15. Ashfaq K, Fragomen AT, Nguyen JT, et al. Correction of proximal tibia varus with external fixation. J Knee Surg, 2012, 25(5):375-384.
16. Tsuchiya H, Abdel-Wanis ME, Sakurakichi K, et al. Osteosarcoma around the knee. Intraepiphyseal excision and biological reconstruction with distraction osteogenesis. J Bone Joint Surg (Br), 2002, 84(8):1162-1166.
17. 唐辉, 沙勇, 李春晓, 等. Ilizarov技术结合髓腔开窗持续冲洗治疗下肢髓内钉所致慢性骨髓炎.中华创伤骨科杂志, 2015, 17(10):868-873.
18. 焦绍锋, 秦泗河, 王振军, 等. Ilizarov技术治疗四肢畸形并发症分析.中华骨科杂志, 2012, 32(3):245-248.
19. 成亮, 徐佳, 柴益民, 等.单边外固定支架与环形外固定支架骨搬运治疗下肢长干骨缺损的疗效及并发症比较.中华创伤骨科杂志, 2015, 17(10):863-867.

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Ilizarov TECHNIQUE FOR TREATMENT OF INFECTION AFTER LIMB SALVAGE OPERATION OF PRIMARY BONE TUMOR

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