不同类型填充物对Masquelet技术诱导膜的影响  

Effects of different spacers on induced membranes in Masquelet technique

作　　者：刘耀辉 薛德挺[1] 高翔[1] 李杭[1] 潘志军[1] Liu Yaohui, Xue Deting,Gao Xiang, Li Hang, Pan Zhijun(Department of Orthopaedics, The Second Hospital Affiliated to Zhejiang University Medical College, Hangzhou 310000, Chin)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310000

出　　处：《中华创伤骨科杂志》2018年第3期271-276,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目前用于治疗骨缺损的技术主要有骨移植、牵张成骨技术及Masquelet技术。其中Masquelet技术因具有操作简单、并发症少等优点而获得广泛应用，尤其是在感染性骨缺损的治疗方面。Masquelet技术第1阶段填充材料对诱导膜的形成过程和质量有重要影响，临床使用最多的是聚甲基丙烯酸甲酯（PMMA）骨水泥，其可以诱导形成富含血管和促成骨物质的膜结构，但不可降解，缺少骨传导性。磷酸钙骨水泥和硫酸钙骨水泥等可降解材料克服了PMMA骨水泥的缺陷，具有生物可吸收性、骨传导性和骨诱导性，无生物毒性，使一步式Masquelet技术成为可能，但力学强度较PMMA骨水泥差。体外实验时硅酸钙骨水泥周围也可以形成纤维组织层，经过改良后可能应用于骨科手术，是潜在的填充剂。硅酮假体周围能形成类似诱导膜的结构，且性能与PMMA骨水泥周围的诱导膜相似，更加耐受放疗环境，在骨肿瘤切除术后骨重建的应用方面较PMMA骨水泥有明显优势。本文通过对比不同类型填充物所诱导产生的膜结构，旨在探讨Masquelet技术实施第1阶段采用不同填充物时诱导膜形成与发展的差异，发现最有利于具有成骨功能膜结构形成和骨折愈合的材料。Bone defects, a challenge in orthopedics, are mostly caused by severe trauma, bone tumor and bone infection. Their chief treatments include bone graft, distraction osteogenesis and Masquelet technique. Compared with other treatments, Masquelet technique is simpler and causes fewer complications, especially for infectious defects. In the first stage of Masquelet technique, a bone defect is filled with bone cement. The spacer most commonly used is polymethylmethacrylate（PMMA）. PMMA can form induced membrane rich in blood vessels and bioactive components promoting osteogenesis, but it is not biodegradable, lacks bone conductibility, has an obvious thermal effect during operation, and is hard to remove in the second phase of Masquelet technique. Calcium sulfate and calcium phosphate bone cement are biodegradable materials which overcome the defects of PMMA due to their biological absorbability, bone conduction and bone inducement. It is possible for them to replace PMMA in Masquelet technique, but their poor mechanical strength limits their application. There is clinical evidence showing that calcium sulfate bone cement can form obvious induced membrane. As calcium silicate cement can also form a layer of fibrous tissue around the shell, it may be applied in orthopaedic surgery after improvement as a potential filling agent. A structure like induced membrane can form around a silicone prosthesis, and it functions similarly as induced membrane around PMMA and is more resistant to a radiation environment. Silicone has obvious advantages over PMMA after resection of bone tumor. Spacers used in the first stage of Masquelet technique have important effects on formation process and quality of induced membranes. By comparing membranes induced by different types of spacer, we can know more about the effects of spacers on induced membranes in the first stage of Masquelet technique and thus discover the most suitable spacers good for fracture healing and membrane formation.

关 键 词：骨缺损 诱导膜 Masquelet技术 骨水泥 

分 类 号：R687.3[医药卫生—骨科学]