诱导膜技术联合皮瓣移植治疗小腿感染性骨及软组织缺损

Masquelet technique combined with flap transplantation for infectious bone and soft tissue defects of lower leg

目的探讨诱导膜技术联合皮瓣移植治疗小腿感染性骨及软组织缺损的疗效。方法 2013年1月-2017年1月,应用诱导膜技术联合皮瓣移植治疗35例小腿感染性骨及软组织缺损。男21例,女14例;年龄25~55岁,平均31.5岁。均为外伤致胫骨骨折,伤后清创或内固定治疗后发生感染,受伤至该次入院时间1~6个月,平均3.2个月。创面部位:小腿上段11例、中段11例、下段13例。清创后胫骨缺损长度为5.6~11.2 cm,平均7.1 cm。软组织缺损范围为14.2 cm×6.9 cm^17.3 cm×8.7 cm。创面脓性分泌物细菌培养阳性18例。入院后彻底清创,一期行骨水泥填充骨缺损以及穿支皮瓣修复创面;8~12周后二期手术取出占位骨水泥,采用自体髂骨或联合人工骨修复骨缺损。结果一期术后3例皮瓣远端边缘发生坏死,经换药后成活;其余患者皮瓣均顺利成活,创面Ⅰ期愈合。二期术后切口均Ⅰ期愈合。患者均获随访,随访时间24~32个月,平均27个月。皮瓣颜色与周围正常组织相似,质地良好。X线片复查示植骨均愈合,愈合时间6~8个月,平均6.7个月。二期术后9个月,根据修正的Edwards胫骨骨折疗效评定标准,获优19例、良14例、差2例,优良率94.3%。美国矫形足踝协会(AOFAS)评分为60~98分,平均81.3分;其中优21例、良11例、中3例,优良率为91.4%。结论诱导膜技术联合皮瓣移植是治疗小腿感染性骨及软组织缺损的一种有效方法。

Objective To investigate the effectiveness of Masquelet technique combined with flap transplantation in treatment of infectious bone and soft tissue defects of the lower leg.Methods Between January 2013 and January 2017,35 cases of infectious bone and soft tissue defects of lower leg were treated with Masquelet technique combined with flap transplantation.There were 21 males and 14 females,with an average of 31.5 years(mean,25-55 years).All patients were tibial fractures caused by trauma and the infections occurred after debridement or internal fixation.The time from injury to admission was 1 to 6 months,with an average of 3.2 months.Defect located at the proximal leg in 11 cases,the middle leg in 11 cases,and the distal leg in 13 cases.The length of tibia defect after debridement ranged from 5.6 to 11.2 cm,with an average of 7.1 cm.The size of soft tissue defect ranged from 14.2 cm×6.9 cm to 17.3 cm×8.7 cm.Bacterial culture of purulent secretion of wound was positive in 18 cases.After debridement,the bone cement was used to fill the bone defect and the flap transplantation was used to repair the wound.The bone cement was taken out at 8 to 12 weeks after the one-stage operation,and the bone defect was repaired with autogenous iliac bone or combined with artificial bone.Results Three cases had necrosis at the distal edge of the flap after one-stage operation,and survived after dressing change.The other flaps survived successfully,and the wounds healed by first intention.All incisions healed by first intention after two-stage operation.All patients were followed up 24-32 months,with an average of 27 months.The color of the flap was similar to that of the surrounding normal tissue,and its texture was good.X-ray reexamination showed that all bone defects healed after 6-8 months,with an average of 6.7 months.At 9 months after two-stage operation,according to the revised Edwards tibial fracture evaluation standard,19 cases were excellent,14 cases were good,and 2 cases were poor,the excellent and good rate was 94.3%.The American Orthopedic Ankle Association(AOFAS)score was 60-98,with an average of 81.3.And 21 cases were excellent,11 were good,and 3 were fair,with an excellent and good rate of 91.4%.Conclusion Masquelet technique combined with flap transplantation is an effective treatment for infectious bone and soft tissue defects of lower leg.