膝关节周围恶性肿瘤保肢术后切口愈合不良的危险因素分析  

Treatment and influencing factors for poor incision healing after limb salvage surgery for malignant tumor around the knee joint

作　　者：汪红胜 沈嘉康[1,2] 左冬青 昝鹏飞 孙伟 WANG Hongsheng;SHEN Jiakang;ZUO Dongqing;ZAN Pengfei;SUN Wei(Department of Bone Oncology,Shanghai General Hospital,Shanghai 200080,China;Shanghai Bone Tumor Institution,Shanghai 200080,China)

机构地区：[1]上海市第一人民医院骨肿瘤科,上海200080 [2]上海市骨肿瘤研究所,上海200080

出　　处：《中华骨与关节外科杂志》2025年第3期237-242,共6页Chinese Journal of Bone and Joint Surgery

基　　金：上海市卫生健康委员会卫生行业临床研究专项基金(20224Y0219)。

摘　　要：目的:分析膝关节周围原发恶性肿瘤保肢术后切口愈合不良的危险因素。方法:回顾性分析2019年1月至2022年12月上海市第一人民医院收治的接受保肢手术的83例膝关节周围原发恶性肿瘤患者的临床资料。对患者以下指标进行分析,包括年龄,性别,肿瘤部位,保肢术前化疗周期、骨髓抑制情况及是否使用靶向药物,保肢术前白蛋白、血红蛋白水平,保肢手术时间,保肢术后引流时间、输血量,以及肿瘤侵犯股四头肌数目。采用单因素Logistic回归分析筛选膝关节周围原发恶性肿瘤保肢术后切口愈合不良的危险因素。结果:本研究83例患者随访4~51个月,中位数(四分位数)为23(17,34)个月。术后切口愈合不良9例(10.8%),其中4例切口边缘皮肤坏死通过定期换药、3例皮瓣坏死通过清创或皮瓣转位、1例感染和窦道形成通过彻底清创灌洗,均治愈;另1例感染和窦道形成清创灌洗失败后,患者拒绝再次手术,带菌生存。单因素Logistic回归分析结果显示,患者年龄<18岁[优势比(OR)=0.614,95%置信区间(95%CI):0.419~0.900,P=0.012]、保肢术前骨髓抑制3~4度(OR=9.385,95%CI:2.074~42.460,P=0.004)及肿瘤侵犯股四头肌数目≥3个(OR=4.917,95%CI:1.175~20.580,P=0.029)是膝关节周围原发恶性肿瘤保肢术后切口愈合不良的危险因素。结论:早期识别切口愈合不良的危险因素,并采取针对性的治疗措施,保证切口顺利愈合,对促进膝关节周围原发恶性肿瘤患者康复和提高肿瘤预后有重要的临床意义。Objective:To analyze the risk factors for poor incision healing after limb salvage surgery for primary malignant tumors around the knee joint.Methods:A retrospective analysis was conducted on the clinical data of 83 patients with primary malignant tumors around the knee joint who underwent limb salvage surgery at Shanghai General Hospital from January 2019 to December 2022.The following indicators of the patients were analyzed including age,gender,tumor location,chemotherapy cycles and bone marrow suppression before limb-salvage surgery,use of targeted drugs,albumin and hemoglobin levels before limb-salvage surgery,duration of limb-salvage surgery,drainage duration after limb-salvage surgery,blood transfusion volume,and the number of quadriceps muscle invaded by tumors.Univariate logistic regression analysis was used to identify risk factors for poor incision healing after limb salvage surgery for primary malignant tumors around the knee joint.Results:A total of 83 patients were followed up for 4 to 51 months,with a median(interquartile range)of 23(17,34)months.Nine patients(10.8%)had poor postoperative incision healing,including 4 cases of incision edge necrosis treated with regular dressing changes,3 cases of skin flap necrosis treated with debridement or skin flap transfer,and 1 case of infection with sinus formation treated with thorough debridement and irrigation,all of which were cured.Another case of infection with sinus formation failed after debridement and irrigation,and the patient refused further surgery,living with infection.Univariate logistic regression analysis revealed that age<18 years[odds ratio(OR)=0.614,95%confidence interval(CI):0.419-0.900,P=0.012],grade 3-4 bone marrow suppression before limb salvage surgery(OR=9.385,95%CI:2.074-42.460,P=0.004),and tumor involvement of 3 or more quadriceps femoris muscles(OR=4.917,95%CI:1.175-20.580,P=0.029)were risk factors for poor incision healing after limb salvage surgery for primary malignant tumors around the knee joint.Conclusions:Early identificat

关 键 词：膝关节周围恶性肿瘤 保肢手术 切口愈合不良 

分 类 号：R738[医药卫生—肿瘤]