Masquelet膜诱导技术联合显微外科技术治疗创伤性胫骨骨缺损的效果

Effect of Masquelet membrane induction technique combined with microsurgical technique in treatment of traumatic tibial bone defect

目的 探讨运用Masquelet膜诱导技术联合显微外科技术治疗胫骨开放粉碎性骨折伴骨缺损的临床疗效。方法 2018年1月-2021年1月,应用Masquelet膜诱导技术联合显微外科技术治疗胫骨开放粉碎性骨折伴骨缺损8例,根据具体伤情急诊予以清创、固定等对症治疗,待创面稳定,连续三次以上培养无细菌后,用含万古霉素的骨水泥占位器填充骨缺损部位,运用显微外科技术修复创面缺损。6~8周待诱导膜形成后取出骨水泥,取自体髂骨加同种异体骨植入诱导膜内修复骨缺损。骨折端予以髓内钉加锁定钢板或者单纯锁定钢板固定。观察术后骨折愈合、功能恢复及并发症发生情况。结果 所有患者均获得随访,随访时间16~30个月,平均(20.0±7.2)个月。所有病例骨缺损均得到骨性愈合,时间11~16个月,平均(11.7±4.2)个月。AOFAS踝-后足评分平均(80.5±4.2)分。2例皮瓣术后伤口周围脂肪液化渗出,行伤口换药后伤口愈合;1例皮瓣臃肿,骨折愈合后取出内固定装置时行皮瓣整形术。结论 运用Masquelet膜诱导技术联合显微外科技术治疗胫骨开放粉碎性骨折伴骨缺损疗效确切,操作相对简单易行,适合基层推广。

Objective To investigate the clinical effect of Masquelet membrane induction technique combined with microsurgical technique in the treatment of open comminuted fracture of tibia with bone defect.Methods From January 2018 to January 2021,8 cases of traumatic tibial bone defect were treated by Masquelet membrane induction technique combined with microsurgery.According to the specific situation of the injury,the emergency treatment such as debridement and fixation was given.After the wound was stabilized and no bacteria was cultured for more than three consecutive times,the bone defect was filled with vancomycin containing bone cement placer,and the wound defect was repaired with microsurgical technology.6~8 weeks after the formation of the induction membrane,the bone cement was taken out,and the iliac crest was implanted with allogeneic bone to repair the bone defect.Fracture ends were fixed with intramedullary nailing plus locking plate or locking plate alone.The fracture healing,functional recovery and complications were observed.Results All patients were followed up for 16~30 months,20.0±7.2 months on average.Bone healing was achieved in all patients in 11-16 months(mean 11.7±4.2 months).AOFAS ankle-hind foot scores were averaged 80.5±4.2.In 2 cases,the fat around the wound was liquefied and exuded,and the wound healed after dressing change.One case had swollen skin flap and underwent flap reconstruction when the internal fixation device was removed after fracture healing.Conclusion The application of Masquelet membrane induction technique combined with microsurgical technique in the treatment of open commotion fracture of tibia with bone defect is effective,relatively simple and easy to operate,and suitable for basic extension.