Masquelet与Ilizarov技术修复感染性胫骨骨缺损比较

Comparison of Masquelet method versus Ilizarov technique for repairing infectious tibial bone defects

[目的]比较Masquelet技术与Ilizarov技术治疗胫骨感染性骨缺损的临床效果。[方法]回顾性分析2017年8月—2020年8月,本院治疗的胫骨感染性骨缺损60例患者的临床资料。依据术前医患沟通结果,35例采用Masquelet诱导膜技术,25例采用Ilizarov骨搬运技术。比较两组围手术期、随访及影像结果。[结果]两组均顺利完成手术,Masquelet组中透视总次数、手术切口愈合等级均显著优于Ilizarov组(P<0.05)。早期并发症方面,Masquelet为3/35 (8.57%),而Ilizarov组为9/25 (36.00%),两组差异有统计学意义(P<0.05)。两组平均随访时间(24.54±5.86)个月。Masquelet组恢复下地行走时间及完全负重活动时间显著早于Ilizarov组(P<0.05)。术后随时间推移,两组患者VAS评分均显著减少(P<0.05),而Iowa膝关节评分、Iowa踝关节评分、SF-36得分均显著增加(P<0.05)。术后6个月和末次随访时,Masquelet组的VAS评分显著优于Ilizarov组(P<0.05);相应时间点,两组Iowa膝关节评分、Iowa踝关节评分、SF-36得分差异均无统计学意义(P>0.05)。影像方面,Masquelet组骨缺损影像愈合时间显著早于Ilizarov组(P<0.05)。[结论] Masquelet技术与Ilizarov技术均可有效治疗胫骨感染性骨缺损,但本研究中Masquelet技术的临床效果优于Ilizarov技术。

[Objective] To compare the clinical outcomes of Masquelet technique versus Ilizarov technique for treatment of infectious tibial bone defects. [Methods] A retrospective study was conducted on 60 patients who received surgical treatment for infectious tibial bone defect in our hospital from August 2017 to August 2020. According to the results of preoperative doctor-patient communication, 35 patients received Masquelet treatment, the induced membrane technique, while the other 25 patients received Ilizarov therapy, the bone transportation. The perioperative, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups had operations completed smoothly. The Masquelet group proved significantly superior to the Illizarov group in terms of total number of intraoperative fluoroscopy and incision healing grade(P<0.05). The early complications were of 3/35(8.57%) in the Masquelet group, whereas 9/25(36.00%) in the Ilizarov group, which was statistically significant between the two groups(P<0.05). During follow-up period lasted for(24.54±5.86) months on an average, the Masquelet group resumed walking and full weight-bearing activity significantly earlier than the Ilizarov group(P<0.05). The VAS score significantly decreased(P<0.05), while Iowa knee score, Iowa ankle score and SF-36 score significantly increased in both groups over time(P<0.05). VAS score in Masquelet group was significantly better than those of Ilizarov group at 6months after surgery and the latest follow-up(P<0.05), although there were no significant differences in Iowa knee score, Iowa ankle score and SF-36 score between the two groups at any corresponding time points(P>0.05). Radiographically, the Masquelet group got healing of the bone defect significantly earlier than the Ilizarov group(P<0.05). [Conclusion] Both Masquelet technique and Ilizarov technique are effective for treatment of infectious tibial bone defects, by contrast, the Masquelet technique does achieve considerably better clinical results than the Ilizarov technique in this study.