Masquelet技术联合组织瓣移植修复骨软组织复合缺损

Masquelet TECHNIQUE COMBINED WITH TISSUE FL AP GRAFTING FOR TREATMENT OF BONE DEFECT AND SOFT TISSUE DEFECT

目的探讨Masquelet技术联合组织瓣移植修复骨软组织复合缺损的疗效。方法 2012年8月-2015年4月,采用Masquelet技术联合组织瓣移植修复18例小腿及足骨软组织复合缺损患者。其中男11例,女7例;年龄23~59岁,平均37.1岁。受伤至该次手术时间15 d^39个月,平均0.9个月。缺损部位:胫骨上段4例,胫骨中段8例,胫骨下段4例,足跟外侧2例。扩创后骨缺损长度(5.7±1.8)cm,软组织缺损范围5 cm×4 cm^13 cm×11 cm。入院后均先行清创处理,待创面好转后,一期手术采用抗生素骨水泥填充骨缺损区,并用外固定支架临时固定,组织瓣修复创面;6~8周后待创面完全愈合、无感染迹象后,二期手术取髂骨或(和)腓骨棒植骨修复骨缺损。结果 18例患者均获随访,随访时间10~38个月,平均24.3个月。一期术后组织瓣均成活;钉道感染6例,经加强消毒护理及口服抗生素后治愈。二期术后植骨均获骨性愈合,愈合时间15~57周,平均25.3周。患者膝、踝关节功能均恢复良好;二期术后6个月按美国矫形足踝协会(AOFAS)踝与后足功能评分评定为74~98分,平均89.7分;其中优7例,良10例,中1例。结论采用Masquelet技术联合组织瓣移植治疗骨软组织复合缺损是一种有效的治疗方法。

Objective To explore the therapeutic effect of Masquelet technique combined with tissue flap grafting for bone defect and soft tissue defect. Methods Between August 2012 and April 2015, 18 cases of bone defect and soft tissue defect were treated by using Masquelet technique combined with tissue flap grafting. There were 11 males and 7 females, aged from 23 to 59 years（mean, 37. 1 years）. The time between injury and treatment was 15 days to 39 months（mean, 0. 9 months）. Defect located at the proximal tibia in 4 cases, at the middle tibia in 8 cases, at the distal tibia in 4 cases, and at the lateral heel in 2 cases. All patients were treated with debridement. After debridement, the bone defect was（ 5. 7 ± 1. 8） cm in length, and the soft tissue defect was 5 cm× 4 cm to 13 cm× 11 cm in size. In one-stage operation, bone defect was repaired with the antibiotic cement and fracture was fixed by temporary external fixation. The surfaces of wound were repaired with tissue flap. After 6 to 8 weeks when wounds healed with no sign of infection, bone grafting from iliac bone and/or fibula was performed in two-stage operation. Results Eighteen patients followed up 10- 38 months（mean, 24. 3 months）. After one-stage operation, 6 cases had pin track infection, which was cured by strengthened disinfection and oral antibiotics. All the tissue flaps survived. Bone healing was observed on X-ray film at 15- 57 weeks（mean, 25. 3 weeks） after two-stage operation. The function of the knee and ankle joint recovered well. According to the American Orthopaedic Foot and Ankle Society（AOFAS） score for the ankle joint, the scores of ankle function ranged from 74 to 98, with an average of 89. 7; the results were excellent in 7 cases, good in 10 cases, and fair in 1 case. Conclusion The Masquelet technique combined with tissue flap grafting is an effective method to treat bone defect and soft tissue defect.