应用Masquelet技术治疗骨缺损

Treatment of bone defects using Masquelet technique

目的探讨应用Masquelet技术治疗骨缺损的疗效。方法回顾性分析2008年1月至2014年12月应用Masquelet技术治疗的20例骨缺损患者资料。男15例，女5例；年龄18—69岁，平均38．4岁。开放性骨折伴骨缺损4例，感染性骨缺损16例。第1阶段常规入路行彻底的骨与软组织扩创，骨缺损长度为2～9cm，平均6．1cm。第2阶段手术采用内固定治疗18例，外固定支架固定2例。第2阶段距第1阶段手术时间6～23周，平均11．5周。末次随访时按Paley的方法分别评定骨缺损愈合和邻近关节功能的恢复情况。结果20例患者术后获12～50个月（平均19．7个月）随访。1例感染性骨缺损患者第1阶段需要2次手术控制感染，其余患者均1次手术后伤口顺利愈合且感染控制。第2阶段手术时4例患者发生明显诱导膜损伤和缺损。所有患者骨缺损临床愈合时间为3—6个月（平均4．8个月）。骨缺损愈合后分级均为优，均恢复负重功能，无固定器断裂和感染发生，感染无复发。末次随访时按Paley的方法评定邻近关节功能恢复情况：优8例，良10例，可2例，优良率为90．0％。结论Masquelet技术是改良的游离植骨方法，治疗骨缺损时除有手术简便、并发症少等特点外，还有骨愈合快、愈合率高及控制骨感染效果较好等优点。

Objective To analyze the therapeutic effect of Masquelet technique in the treatment of bone defects. Methods From January 2008 to December 2014, 20 patients with bone defects were treated by Masquelet technique. There were 15 males and 5 females, from 18 to 69 years of age （average, 38.4 years）. Four cases had open bone defects and 16 infectious ones. At the first stage, radical debridement of the bone defects and soft tissue was conducted via conventional approaches. The bone defects ranged from 2 to 9 cm, averaging 6. 1 cm. At the second stage, internal fixation was applied in 18 cases and external fixation in 2. The interval from the second stage to the first stage operation ranged from 6 to 23 weeks （average, 11.5 weeks） . The healing of bone defects and the functional recovery of adjacent joint were evaluated by Paley scoring at the last follow-up. Results The 20 patients were followed up for 12 to 50 months （average, 19. 7 months） after the second stage operation. All the patients obtained uneventful wound healing and control of infection after the first stage operation except the one with infectious defects who had to receive 2 operations to control the infection at the first stage operation. At the second stage operation, obvious injury and defect of the induced membrane occurred in 4 cases. All the patients achieved clinical healing of bone defects after 3 to 6 months （average, 4. 8 months）. The bone defect healing was graded as excellent in all. After bone healing, all the patients resumed weight-bearing activities, with no breakage or infection of fixators, or recurrence of infection. By the Paley scoring at the last follow-up, the functional recovery of the adjacent joint was excellent in 8 cases, good in 10 and fair in 2, yielding an excellent and good rate of 90.0%. Conclusion As a kind of modified free bone grafting, Masquelet technique has advantages of simplicity, limited complications, a high rate of healing, and good control of bone infection.