Masquelet技术治疗长骨骨缺损并发症分析

Complications of induced membrane technique for the treatment of long bone segmental defects

目的分析Masquelet技术治疗长骨骨缺损的并发症情况。方法回顾性分析自2012年1月至2016年9月沈阳军区总医院骨科收治的39例长骨骨缺损患者的临床资料。所有患者均采用Masquelet技术治疗,Ⅰ期清创后骨缺损长度2.0~18.5 cm,在骨缺损处填塞抗生素骨水泥诱导生物膜形成,Ⅱ期在膜内植骨重建骨缺损。观察膜诱导技术治疗骨缺损的临床疗效。结果本组39例患者,术后随访6~36个月,其中,87.2%(34/39)获得骨性愈合,1例(2.6%)患者出现切口浅部感染,1例(2.6%)患者因深部感染截肢,1例(2.6%)患者肿瘤术后复发截肢,3例(7.7%)患者(1例骨肿瘤,1例骨不连,1例骨髓炎)植骨区骨吸收、再次行膜诱导技术植骨愈合,2例(5.1%)患者因感染选择其他治疗方式,无取骨处疼痛、肢体短缩、医源性神经损伤、足下垂、关节僵硬等并发症发生。结论 Masquelet技术可以有效治疗各种疾病所致的骨缺损,并发症主要有感染、骨吸收,需要进一步在终极治疗前控制感染,预防并发症。

Objective To investigate the complications of induced membrane technique for reconstruction of long bone seg-mental defects. Methods A retrospective study was performed on 39 cases of patients with long bone segmental defects who were admitted from January, 2012 to September 2016. All patients received Masquelet technique treatment,length of bone defect was 2. 0 to 18. 5 cm after debridement in phase I ,antibiotic bone cement was filled in bone defect to induce biofilm formation,graft reconstruction was performed inside the membrane in phase n . The curative effect of induced mem-brane technique for reconstruction treatment in bone defect was observed. Results The 39 patients were followed up for 6 to 36 months postoperatively. Among the patients, 87. 2% （34/39）was osseous healing, 1 case（2. 6% ）had superficial infec-tion of incision,1 case（2. 6% ）received amputation induced by tumor recurrence,3 cases （7.7%,1 case of bone tumor, 1 case of bone nonunion and 1 case of osteomyelitis） of graft bone resorption and secondary induced membrane technique for reconstruction treatment,2 cases（5. 1% ）received other treatment because of infection,there was no pain in location of tak-ing bone, limb shortening, iatrogenic complications such as nerve damage, foot drop or stiff joints occurred. Conclusion Masquelet technique can effectively treat the bone defects caused by various diseases. The complications mainly include infection and bone absorption, w-hich needs to control the infection before the ultimate treatment and prevent the complica-tions.