Masquelet技术联合皮肤牵张技术治疗Gustilo Ⅲ型开放性骨折的效果分析

Therapeutic effect of Masquelet technique combined with skin-stretching technique for the treatment of GustiloⅢopen fractures

目的探讨Masquelet技术联合皮肤牵张技术治疗GustiloⅢ型开放性骨折的效果。方法回顾性分析2014年1月—2018年1月桂林市人民医院应用Masquelet技术联合皮肤牵张技术治疗的17例GustiloⅢ型开放性骨折患者病历资料。男性14例,女性3例;年龄18~58岁,平均38.7岁;骨折分型GustiloⅢb型15例,GustiloⅢc型2例;Tscherne软组织损伤分类2级11例,3级6例;胫腓骨16例,尺桡骨1例;伴有骨缺损6例。受伤至入院时间47~485min,平均205.4min;入院后初次手术时间35~72min,平均46.2min。观察患者术后骨折愈合、皮瓣覆盖及感染等并发症发生情况。结果患者均通过门诊随访,时间18~48个月,平均25.6个月。患者手术2~5次,平均3.4次;骨折均达到临床愈合,愈合时间6~11个月,平均8.2个月。2例出现感染控制不佳,通过2~3次骨水泥植入后植骨愈合。2例术后骨水泥外露,通过Ⅱ期手术创面完全闭合。1例出现皮肤边缘部分坏死,Ⅱ期手术清创后创面完全闭合。结论Masquelet技术和皮肤牵张技术在治疗GustiloⅢ型开放性骨折中优缺点互补,能够在覆盖创面同时很好地控制感染,效果良好。

Objective To discuss the effect of Masquelet technique combined with skin-stretching technique in the treatment of GustiloⅢopen fracture.Methods Retrospective analysis was performed on the medical records of 17 patients with GustiloⅢopen fracture treated with Masquelet technique combined skin-stretching technique in Guilin People's Hospital from Jan.2014 to Jan.2018.There were 14 males and 3 females,with an average age of 38.7 years old,ranging from 18 to 58 years.There were 15 cases of type GustiloⅢb and 2 cases of GustiloⅢc.The classification of soft tissue injury was Tscherne2(11 cases)and Tscherne3(6 cases).There were 16 cases of tibiofibula and 1 case of ulna and radius.There were 6 patients with bone defect.The time from injury to admission was 47-485min,with an average of 205.4min.The initial operation time after admission was 35-72min,with an average of 46.2min.Complications such as fracture healing,flap coverage and infection were observed.Results All patients were followed up at the outpatient clinic for 18 to 48 months,with an average of 25.6 months.The patients underwent a total of 2-5 surgeries,with an average of 3.4,and all fractures were clinically healed.The healing time was 6-11 months,with an average of 8.2 months.Two patients showed poor infection control and healed with bone grafting after 2-3 times of bone cement placement.The bone cement was exposed in 2 cases after operation,and the wound surface was completely closed through the stageⅡoperation.One patient had partial skin edge necrosis,and the wound was completely closed after stageⅡsurgical debridement.Conclusion Masquelet technique combined with skin-stretching technique is complementary in the treatment of GustiloⅢopen fracture,which can cover the wound surface and control the infection at the same time with good results.