改良Masquelet技术结合组织瓣修复小腿骨软组织复合缺损的效果及对骨缺损愈合的影响

Effect of Modified Masquelet Technique Combined with Tissue Flaps in Repairing Leg Bone Defect and Soft Tissue Defect and the Influence on Bone Defect Healing

目的:探讨改良膜诱导(Masquelet)技术结合组织瓣修复小腿骨软组织复合缺损的效果及对骨缺损愈合的影响。方法:回顾性分析2019年10月-2021年12月于江西嘉佑曙光骨科医院手足外科进行治疗的63例因高能量损伤导致的小腿开放骨折伴骨、软组织缺损的患者临床资料,依据治疗方法不同分成对照组32例与观察组31例,两组均予以组织瓣修复,对照组采取单纯植骨术,观察组运用改良Masquelet技术,对两组治疗效果、踝关节功能、围手术期指标、生活质量及并发症发生率进行评估比较。结果:观察组术后6周临床总有效率、术后6周、6个月、1年的美国足踝外科协会(AOFAS)评分、术后6周生活质量综合评定问卷(GQOLI-74)评分均明显高于对照组(P<0.05),创面愈合时间、住院时间及清创至手术时间均显著短于对照组(P<0.05),并发症发生率明显低于对照组(P<0.05)。结论:对小腿骨软组织复合缺损患者予以改良Masquelet技术结合组织瓣修复疗效明显,在促进患者踝关节功能恢复,加快骨缺损愈合,提高生活质量方面优势显著。

Objective:To investigate the effect of modified induced membrane(Masquelet)technique combined with tissue flaps in repairing leg bone defect and soft tissue defect,and the influence on bone defect healing.Method:This study retrospectively reviewed 63 patients with open leg fracture complicated with bone defect and soft tissue defect caused by high-energy injury who were treated in Jiangxi Jiayou Shuguang Orthopedic Hospital from October 2019 to December 2021.According to different treatment methods,the subjects were divided into the control group(32 cases)and the observation group(31 cases).Both groups were treated with tissue flaps,the control group was treated with simple bone grafting,while the observation group was treated with modified Masquelet technique.Therapeutic effects,ankle function,quality of life,perioperative indicators and the incidence rates of complications in two groups were evaluated.Result:The clinical total effective rate at 6 weeks after surgery,American orthopaedic foot and ankle society(AOFAS)score at 6 weeks,6 months,1 year after surgery,and general quality of life inventory(GQOLI-74)score at 6 weeks after surgery in the observation group were significantly higher than those in the control group(P<0.05).The wound healing time,length of hospital stay and debridement to operation time in the observation group were significantly shorter than those in the control group(P<0.05).The incidence of complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:Modified Masquelet technique combined with tissue flaps is effective in repairing leg bone defect and soft tissue defect.It has obvious advantages in promoting ankle function recovery,accelerating bone defect healing,and improving quality of life.