三阶段Masquelet技术在足踝部感染性骨缺损中的应用  

Application of three-stage Masquelet technique for infective bone defects of foot and ankle

作　　者：余黎[1] 汪冰[1] 谢哲 邓玲珑[1] 魏驰[1] 邓凯[1] 余国荣[1] 祝少博[1] Yu Li;Wang Bing;Xie Zhe;Deng Linglong;Wei Chi;Deng Kai;Yu GuoRong;Zhu Shaobo(Department Traumatic Reconstruction Surgery/Foot and Ankle Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院创伤修复/足踝外科,武汉430071

出　　处：《中华创伤杂志》2018年第11期1007-1013,共7页Chinese Journal of Trauma

基　　金：湖北省自然基金面上项目（2016CFB455）;教育部“留学回国人员科研启动基金”（230303）;武汉大学中南医院培育基金（018303033）

摘　　要：目的探讨三阶段Masquelet技术在足踝部感染性骨缺损治疗中的临床疗效。方法采用回顾性病例系列研究分析2014年12月-2017年10月武汉大学中南医院收治的19例足踝部感染性骨缺损患者的临床资料，其中男15例，女4例；年龄18～68岁[（39．6±12．3）岁]。16例为细菌感染，3例为结核杆菌。感染累及胫骨末端、距骨及其周围关节14例，内踝2例，中足及跗骨间关节1例，跖骨及跖趾关节2例。手术分为三阶段：第一阶段彻底清创并辅以负压封闭引流（VSD）持续冲洗，明确致病菌；第二阶段用针对性抗生素骨水泥填充骨缺损，预防或治疗感染；第三阶段为抗生素骨水泥充填3个月后，局部伤口无感染征象，取出骨水泥，应用内固定植骨的方式行骨重建手术。观察皮瓣存活和创面愈合情况，记录骨折愈合时间。术前及末次随访采用美国足踝外科协会（AOFAS）评分和视觉模拟评分（VAS）评价患者足踝部功能及疼痛改善情况，按照放射学骨愈合评分标准（RUST）评价骨愈合情况。结果患者均获随访9～12个月[（11．1±1．0）个月]。2例内踝皮肤因术前感染坏死致软组织缺损，于第二阶段手术时分别行胫后动脉穿支皮瓣和股前外侧皮瓣修复，皮瓣均完全存活。术后骨愈合时间3～7个月[（3．5±1．4）个月]。19例患者经过三阶段手术，足踝部创面或窦道均愈合，随访期间无感染复发。末次随访AOFAS评分为（71．4±5．7）分，较术前（36．3±12．1）分明显提高（P〈0．05）。VAS为（1．4±0．9）分，较术前（5．3±1．2）分显著下降（p〈0．05）。末次随访时RUST骨愈合评分为8～12分[（10．2±1．1）分]。结论应用Masquelet技术分三阶段治疗足踝部感染性骨缺损，能有效控制感染，利于创面愈合，促进骨性愈合，改善足踝部功能，并减轻疼痛。Objective To investigate the clinical efficacy of three-stage Masquelet technique in the treatment of infective bone defects of foot and ankle. Methods A retrospective case series study was conducted on the clinical data of 19 patients with infective bone defects of foot and ankle admitted to Zhongnan Hospital of Wuhan University from December 2014 to October 2017. There were 15 males and four females, aged 18-68 years [ （39.6 ± 12.3 ）years ]. Among the patients, 16 patients were infected with bacteria and three patients were infected with Mycobacterium tuberculosis. The infection involved humeral end, talus and surrounding joints in 14 patients, internal hemorrhoids in two patients, midfoot and interphalangeal joints in one patient, and humerus and metatarsophalangeal joints in two. The operation included three stages： the first stage was thorough debridement, supplemented with negative pressure closed drainage （VSD） and continuous washing to clarify the pathogenic bacteria; the second stage was to fill the bone defect with targeted antibiotic bone cement to prevent or treat infection; in the third stage, after filling the antibiotic bone cement for 3 months with no sign of local wound infection, the bone cement was taken out, and the bone reconstruction operation was performed by means of internal fixation and bone grafting. The flap survival and wound healing were observed, and the time of fracture healing was recorded. The American Orthopaedic Foot and Ankle Society （AOFAS） score and the Visual Analogue Score （VAS） were used to evaluate the improvement of the function of the foot and ankle before operation and at the last follow-up, and the bone healing was evaluated according to the radiographic union scale in tibial （RUST） fractures. Results The patients were followed up for 9-12 months [ （ 11.1 ± 1.0）months]. Two patients with soft tissue defects caused by preoperative infection and necrosis received posterior tibial artery perforator flap and anterolateral thigh flap repair in

关 键 词：感染 足损伤 Masquelet技术 

分 类 号：R687.3[医药卫生—骨科学]