Masquelet技术治疗枪弹伤所致四肢开放性骨折

Masquelet technique used for open limb fractures caused by gunshots

目的观察Masquelet技术治疗枪弹伤所致四肢开放性骨折的疗效。方法回顾性分析2016年1月到2018年7月解放军联勤保障部队第九二〇医院附属骨科医院收治的3例因枪弹伤所致的长骨开放性粉碎性骨折患者资料。均为男性,年龄18~41岁,平均30.7岁;均为贯通伤,均为GustiloⅢB型开放性骨折;长骨缺损5~9 cm,平均6.7 cm;2例骨缺损位于股骨近段,1例骨缺损位于肱骨中上段。均按照标准Masquelet方法给予两阶段手术治疗。术后采用Harris髋关节评分、Lowa膝关节评分和Constant-Murley肩关节功能评分标准分别评价髋关节、膝关节和肩关节功能。结果3例患者术后获平均17.3个月随访。3例患者骨缺损全部修复愈合,无感染征象。2例股骨骨缺损患者根据Harris髋关节评分评定2例均为优,根据Lowa膝关节功能评分评定疗效:优1例,良1例。肱骨骨缺损患者根据Constant-Murley肩关节功能评分评定为优。结论Masquelet技术是治疗枪弹导致长骨骨缺损的有效方法。

Objective To report our experience of treating open comminuted limb fractures caused by gunshots using the Masquelet technique.Methods Between January 2016 and July 2018,3 patients were admitted to Institute of Orthopedics,920 Hospital of Joint Logistic Service of People's Liberation Army for open comminuted limb fractures caused by gunshots.They were all male,aged from 18 to 41 years(average,30.7 years).Their fractures were complicated with perforating wounds and belonged to Gustilo typeⅢB for open fractures.The bone defects were 5 to 9 cm in length(average,6.7 cm),located at the proximal femur in 2 cases and at the upper middle humerus in one.They were treated by standard Masquelet technique at 2 stages.The postoperative functions of the hip,knee and shoulder were evaluated according to the Harris hip score,Lowa knee score and Constant-Murley shoulder function score.Results The 3 patients obtained an average follow-up of 17.3 months.The bone defects were all repaired in the 3 patients without any signs of infection.The 2 patients with femoral defects were rated as both excellent by the Harris hip score,as excellent in one and as good in the other by the Lowa knee score;the patient with humeral defects was rated as excellent by the Constant-Murley shoulder function score.Conclusion Masquelet technique is a desirable treat-ment of segmental long bone defects caused by gunshots.