Masquelet诱导膜技术修复胫骨感染性缺损  

Restoration of long bone defects of infected tibia with induced membrane technique

作　　者：谢利军[1] 李杭[1] 潘志军[1] 李伟栩[1] 郑强[1] 薛德挺[1] 谭延斌[1] Xie Lijun;Li Hang;Pan Zhijun;Li Weixu;Zheng Qiang;Xue Deting;Tan Yanbin(Department of Orthopaedics,The Second Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,310009

出　　处：《中华创伤骨科杂志》2018年第10期860-865,共6页Chinese Journal of Orthopaedic Trauma

基　　金：杭州市卫生科技计划项目（2012FR017）

摘　　要：目的探讨应用Masquelet诱导膜技术修复胫骨感染性大段缺损的疗效。方法回顾性分析2004年1月至2017年1月浙江大学医学院附属第二医院骨科应用Masquelet诱导膜技术修复的44例胫骨感染性大段缺损患者资料，男31例，女13例；年龄18，71岁，平均43．7岁；基础疾病：糖尿病17例，原发性高血压13例，同时伴有以上两种基础疾病12例；骨缺损范围6。17cm（平均11cm）。观察患者术后骨折愈合与并发症发生情况。结果所有患者经历2～5次（平均3．7次）手术均获骨愈合，愈合时间9～13个月（平均11．3个月）。随访时间16个月至11年（平均3．1年）。15例出现相关并发症19处：骨水泥植入创面愈合不良需手术处理5处，第一阶段骨水泥植入感染复发再次清创8处，骨缺损17cm植骨后局部血肿形成1处，内固定物断裂1处，肢体不等长大于2cm 3处，骨愈合后感染再发1处。结论采用Masquelet诱导膜技术修复胫骨感染性缺损疗效好，并发症发生率低。Objective To evaluate the induced membrane technique （Masquelet technique） used for restoration of long bone defects of infected tibia. Methods This retrospective study evaluated 44 patients with long bone defect of infected tibia who had been treated at Department of Orthopedics, The Second Affiliated Hospital by the induced membrane technique between January 2004 and January 2017. They were 31 males and 13 females, aged from 18 to 71 years （mean, 43.7 years） . Of them, 17 were complicated with diabetes, 13 with primary hypertension, and 12 with more than two basic diseases. Their bone de- fects ranged from 6 to 17 cm （average, 11 cm） . Their postoperative fracture healing and complications were observed. Results This cohort received from 2 to 5 operations on average （average, 3.7 opera- tions）. All the patents obtained bony union after 9 to 13 months （average, 11.3 months）. Their follow-ups ranged from 16 months to 11 years （average, 3.1 years） . Nineteen complications related to the surgery oc- curred in 15 cases. Skin healing problem after implantation of bone cement was found in 5 cases which called for operative intervention, infection relapsed in 8 patients after the first phase of cement implantation which necessitated further surgical debridement for successful management, local haematoma appeared after bone grafting in one case of 17 em bone defect, implant failure occurred in one case, leg length discrepancy larger than 2 em was observed in 3 cases, and a discharging sinus developed in one case 2 years after successful healing of a tibial defect. Conclusions The induced membrane technique appears to be a good alternative management for large tibial defects secondary to infection. The technique should be considered in the surgeon＇s armamentarium and patients conditions as it is effective and associated with a low rate of complications.

关 键 词：胫骨 感染 骨重建 骨缺损 诱导膜 

分 类 号：R687.3[医药卫生—骨科学]