Masquelet膜诱导技术治疗股骨粗隆间慢性骨髓炎的疗效分析

Clinical efficacy of Masquelet membrane induction technique in treatment of chronic femoral intertrochanteric osteomyelitis

目的 分析Masquelet膜诱导技术治疗股骨粗隆间慢性骨髓炎的临床疗效。方法 回顾性分析自2015-01—2018-04采用Masquelet膜诱导技术治疗的12例股骨粗隆间慢性骨髓炎,一期清创手术:对血供差的瘢痕、感染后的坏死性骨组织、软组织充分清除;骨缺损部位填充抗生素骨水泥,以诱导生物膜形成,取病灶进行细菌培养,若结果为阳性,予以再次清创手术。一期手术后6~9周进行二期手术:将填充的骨水泥充分取出后,清除缺损断端的瘢痕组织,疏通髓腔;取髂骨(部分患者取自体腓骨)内侧全层骨及松质骨,将其剪切成为小骨块,将颗粒状骨块置入诱导膜中。结果 本组均获得随访,随访时间7~24个月,平均13.8个月。11例(91.67%)获得骨性愈合,骨折愈合时间为5~15个月,平均9.2个月。1例术后出现浅部感染,3例出现骨吸收,予以对症处理后均治愈。末次随访时根据Johner-Wruhs标准评定肢体功能:优7例,良4例,可1例,优良率91.67%。末次随访时的红细胞沉降率、白细胞计数、降钙素原水平及C-反应蛋白水平均较术前降低,差异有统计学意义(P<0.05)。结论 Masquelet膜诱导技术治疗股骨粗隆间慢性骨髓炎的临床疗效满意,有助于抑制感染并降低并发症发生率,值得临床推广。

Objective To explore the early clinical efficacy of Masquelet membrane induction technology in the treatment of chronic femoral intertrochanteric osteomyelitis.Methods The clinical data of 12 patients with chronic osteomyelitis between the femoral trochanters admitted to our hospital from January 2015 to April 2018 were retrospectively analyzed,all of these patients were treated with Masquelet membrane induction technology in stages,and stage I debridement was performed.The bone defect was filled with antibiotic bone cement to induce biofilm formation,and bacterial culture was performed after the operation.If the result was positive,they were debrided again.After 6 to 9 weeks,the second-stage operation was performed:remove the bone cement and the scar tissue from the defect;Bone graft in induction membrane.And the healing time of the fracture was counted after the operation,the limb function was evaluated,the occurrence of complications was recorded,and the inflammatory reaction was followed up.Results All patients were followed up for 7-24 months,with an average follow-up time of 13.8 months.Among them,11 patients had bone union,the first stage fracture healing rate reached 91.67%,the healing time was 5-15 months,and the average healing time was 9.2 months.The excellent and good rate of operation in 12 patients reached 91.67%,one patient developed superficial infection after operation,and 3 patients developed bone resorption,they were all cured after symptomatic treatment.At the last follow-up,the ESR,white blood cell count,PCT levels and CRP levels were lower than those before the operation(P<0.05).Conclusion The Masquelet membrane induction technology has significant early clinical effects in treating chronic intertrochanteric osteomyelitis of the femur.It can help to promote the cure of chronic intertrochanteric osteomyelitis,prevent complications,as well as promote the improvement of patients′ inflammatory indexes.