Masquelet技术治疗成人股骨干慢性骨髓炎早期疗效分析

The early efficacy of Masquelet technique in the treatment of chronic osteomyelitis of adult the femoral shaft

目的探讨Masquelet技术治疗成人股骨干慢性骨髓炎的早期临床疗效。方法选取沈阳军区总医院自2012年1月至2016年1月收治的21例股骨干慢性骨髓炎患者,其中,开放骨折18例,闭合骨折3例。所有患者采用Masquelet技术分2个阶段治疗,Ⅰ期行感染病灶清创术,术后骨缺损长度为3~15 cm,平均(6.5±1.2)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,观察和评估Masquelet技术治疗股骨干慢性骨髓炎的临床疗效。记录患者术前和末次随访视觉模拟量表(VAS)评分、膝关节特种外科医院(HHS)评分及术后并发症发生情况。结果本组21例患者均获随访12~60个月,平均(38.0±1.5)个月。末次随访时VAS及膝关节HHS评分分别为(1.7±0.7)分和(85.1±2.1)分,较术前(4.8±0.8)分和(58.9±6.1)分均明显改善,差异均有统计学意义(P<0.01)。2例患者Ⅰ期清创后皮肤缺损较大行皮瓣移植术,皮瓣均成活,1例出现膝关节僵直,另1例无术后并发症发生。X线影像显示,19例患者骨折愈合,愈合时间4~10个月,平均(6.0±1.2)个月;2例Ⅱ期出现植骨处骨吸收,再次接受植骨手术后达到骨愈合。结论 Masquelet技术Ⅰ期能彻底清除感染灶,形成完整的诱导膜,提供良好的骨愈合微环境,Ⅱ期能有效修复清创后大段骨缺损,患肢功能恢复良好,临床疗效满意。

Objective To evaluate the clinical efficacy of early Masquelet treatment of adult femoral shaft chronic osteomyelitis. Methods A retrospective study was performed on 21 cases of patients with chronic osteomyelitis of femoral shaft who were admitted from January 2012 to January 2016,including 18 cases were open fractures of femoral stem and 3 cases of closed fractures. All patients were divided into 2 phases by Masquelet treatment. In phase Ⅰ,infection debridement was performed,the postoperative bone defect length was 3 to 15 cm,the average( 6. 5 ± 1. 2) cm,formed in the bone defect with antibiotic bone cement induced biofilm; in phase Ⅱ,bone graft for reconstruction of bone defect was performed in the film,clinical observation and evaluation of Masquelet technique in the treatment of chronic osteomyelitis of the femoral shaft was practiced. The preoperative and final follow-up( VAS) pain score,hospital for special surgery( HHS) score( knee score) and postoperative complications were recorded. Results A total of 21 patients were followed up 12 to 60 months,average( 38. 0 ± 1. 5) months. The last follow-up VAS,HHS scores was( 1. 7 ± 0. 7) scores and( 85. 1 ± 2. 1) scores,respectively,compared with the preoperative( 4. 8 ± 0. 8) scores and( 58. 9 ± 6. 1) scores,the improvement was significant,and the difference was statistically significant( P < 0. 01). In 2 cases of patients in phase Ⅰ received debridement for large skin defect flap and flap survived,one case of stiffness of knee joint,the other one had no complications. According to X-ray image display,19 cases were fracture healing,the healing time ranged from 4 to 10 months,the average( 6. 0 ± 1. 2) months. Two cases appeared bone graft bone resorption and again achieved bone healing after bone graft surgery in phase Ⅱ. Conclusion Masquelet phase can completely remove the focus of infection and provide a good bone healing microenvironment in phaseⅠ,can effectively repair the large bone defect after debridement,limb function recovery well in phase Ⅱ,and clinical curative effect is satisfactory.