Masquelet技术结合En bloc切除治疗Cierny-MaderⅣB型骨髓炎的疗效分析

Efficacy analysis of Masquelet technique combined with En bloc excision in the treatment of Cierny-Mader type IV B osteomyelitis

目的:探讨Masquelet技术结合en bloc切除对Cierny-MaderⅣB型骨髓炎的治疗效果.方法:回顾性研究2017年6月—2021年6月收治的8例下肢骨髓炎患者.其中,男性5例,女性3例;患者年龄21~67岁,平均年龄(43.8±23.4)岁;针对其缺损部位:股骨干1例,胫骨干6例,跟骨1例;Cierny-Mader分型选择ⅣB型.将Masquelet技术和en bloc结合,分期治疗.观察患者感染治愈、骨及创面覆盖软组织愈合、肢体功能活动及并发症情况.结果:8例患者术后获6-18个月随访,在随访中未发现复发.患者最后一次复查炎症指标时,数据均保持正常水平,例如白细胞、降钙素原(PCT)、C反应蛋白(CRP)等.比较手术前、后炎症指标,差异有统计学意义.感染清除率100%(8/8).所有患者于术后5-8个月,平均(6.1±1.2)个月获得骨折及创面覆盖软组织的愈合,并最终能独立行走.8例患者术后关节功能恢复良好,均无并发症.结论:Masquelet技术结合en bloc切除能清除感染,促进骨折及创面覆盖软组织的愈合与肢体功能的恢复,是治疗Cierny-MaderⅣB型骨髓炎骨缺损简单、有效的方法.

Objective To investigate the therapeutic effect of Masquelet technique combined with en bloc resection on Cierny-Mader IV B osteomyelitis.Methods A retrospective study was performed on 8 cases of lower extremity osteomyelitis admitted from June 2017 to June 2021,with 5 male and 3 female patients.The age of the patient was 21-67 years old,the average age was(43.8±23.4)old,and the defect site was 1 case of femoral shaft,6 cases of tibial shaf,and 1 case of calcaneus;Cierny-Mader classification selects type IV.B.Masquelet technology is combined with en bloc for staged treatment.Observe the patient's infection healing,bone and wound covering soft tissue healing,limb functional activities and complications.Results Eight patients were followed up for 6-18 months after surgery,and no recurrence was found during the follow-up.When the patient last reviewed inflammatory indicators,the data remained normal,such as white blood cells,PCT,CRP,etc.The two groups of data were compared before and after surgery,and the results were statistically significant.Infection clearance 100%(8/8).All patients were able to heal the fracture and the soft tissue covered by the wound 5-8 months after the operation,the average duration was(6.1±1.2)months,and finally be able to walk independently.The joint function of the 8 patients recovered well after surgery,and all of them had no complications.Conclusion Masquelet technique combined with en bloc resection can clear infection,promote the healing of fractures and wound covered soft tissues and restore limb function,and is a simple and effective method for the treatment of bone defects in Cierny-Mader IV B osteomyelitis.