Masquelet技术治疗长骨骨髓炎骨缺损的临床分析

Clinical observation of Masquelet technique in treatment ofosteomyelitis bone defects of long bones: report of 25 cases

目的探讨Masquelet技术治疗长骨骨髓炎骨缺损的初步临床效果。方法回顾性分析2012年6月至2013年5月本科收治的25例长骨骨髓炎患者的临床资料，对Masquelet技术治疗长骨骨髓炎的临床疗效和局部使用的不同剂量的万古霉素对骨愈合过程可能产生的影响进行评价。结果25例患者随访时间6～18个月，22例患者末次随访获得了影像学骨愈合。根据SamanthaX线评分标准，常规剂量组与大剂量组术后4个月Samantha评分分别是4．16和3．90。局部常规剂量抗生素组（12例），1例切口延迟愈合，3例炎症复发。局部大剂量抗生素组（10例），术后无复发病例。结论Masquelet技术是一种可靠、易行的骨髓炎治疗办法，特别在感染、创伤引起的大段骨重建中具有显著优势。骨水泥中含有大剂量万古霉素比普通剂量的万古霉素骨水泥控制骨髓炎炎症的效果更好。

Objective To determine the clinical outcomes of Masquelet technique in the treatment of osteomyelitis bone defects of long bones. Methods A total of 25 patients suffering from osteomyelitis defects of the long bones admitted in our department during June 2012 to May 2013 were recruited and retrospectively analyzed in this study. Clinical effects of the treatment and the probable influence of different local dosage of vancomycin on bone union were evaluated. Results All 25 cases were followed for 6 to 18 months. Twenty- two cases acquired bone union radiologically at the last follow-up. The average Samantha scores were 4.16 and 3.90 respectively in ordinary dosage group and high dosage group in 4 months postoperatively. Among the 12 cases receiving ordinary vancomycin, PMMA （polymethylmethacrylate bone cements ）, delayed healing of incision was seen in 1 case and relapse of infection were observed in 3 cases. There was no recurrence case found in high vancomycin PMMA group. Conclusion Masquelet technique is a reliable and simple approach in the treatment of osteomyelitis, and has advantages in the reconstruction of large long bone defects resulted from infection or trauma. PMMA with high dose of vancomycin is superior to ordinary vancomycin PMMA in attenuation of infection.