改良Masquelet技术联合Ilizarov Mini-Fixator治疗掌指骨大段骨缺损的临床疗效  

Clinical effect of modified Masquelet technique combined with Ilizarov Mini Fixator in the treatment of segmental metacarpophalangeal bone defects

作　　者：李发祥 方有生[2] 艾克拜尔·亚森 谭玉忠 崔留超 田林 LI Faxiang;FANG Yousheng;AI Kebaier·yasen(Department of Wound Repair Microsurgical,Hospital of Chongqing Great Wall,Chongqing,400041,China)

机构地区：[1]重庆长城医院创伤修复显微外科中心,重庆400041 [2]上海华山医院手外科,上海200040

出　　处：《实用手外科杂志》2023年第1期36-40,共5页Journal of Practical Hand Surgery

摘　　要：目的探讨改良Masquelet技术联合Ilizarov Mini-Fixator外固定治疗掌指骨大段骨缺损的可行性、临床应用及疗效分析。方法回顾性分析2019年11月-2021年10月符合手术适应证的掌指骨大段骨缺损17例患者的病历资料,均行改良Masquelet技术联合Ilizarov Mini-Fixator外固定治疗。⑴创伤性骨缺损:一期急诊行“地毯式”清创及相应修复手术,抗生素聚甲基丙烯酸甲酯(Polymethylmethacyrlate,PMMA)填充骨缺损,皮肤软组织缺损者同时给予骨水泥覆盖;二期:行带蒂皮瓣或植皮修复皮肤缺损创面,伤口愈合6~8周后去除骨水泥行自体骨移植联合Ilizarov Mini-Fixator外固定治疗;⑵感染性骨缺损:一期彻底清创、PMMA填充骨缺损,皮肤软组织缺损或皮肤软组织条件较差者给予彻底清创修复创面;二期方案同创伤性骨缺损。术后均给予预防或控制感染、观察患指(肢)及皮瓣血运等对症处理,均早期(2周)进行功能康复训练。结果17例术后随访5~29个月,移植骨均愈合,平均愈合时间11.9周(10.5~14.0周),术后均未出现伤口感染及皮瓣坏死等并发症。16例伤口均甲级愈合,1例延期愈合,移植骨愈合优良率为82.35%。根据随访结果,骨折愈合康复结束后手部功能评估:优5例,良8例,可4例,优良率为70.47%。均实现保指(肢)的目的,部分患者获得较好的手功能。结论应用改良Masquelet技术联合Ilizarov Mini-Fixator治疗掌指骨创伤性及感染性大段骨缺损的方法疗效可靠,具有操作简单、经济实用、损伤小,且移植骨愈合率高、愈合快、并发症及风险小等优点。可早期进行功能训练,有助于恢复手的外观及功能。Objective To investigate the feasibility,clinical application and curative effect of mod ified Masquelet technique combined with Ilizarov Mini Fixator external fixation in the treatment of segmental metacarpophalangeal bone defects.Methods This study was a retrospective evaluation of 17 patients,with segmental meta-carpophalangeal bone defects from November 2019 to October 2021.All patients underwent with modified Masquelet technique combined with Ilizarov Mini Fixator external fixation.Traumatic bone defect:Phase I radical debridement and related repair were performed in emergency,the bone defect was placed a cement spacer(antibiotic polymethylmethacrylate,PMMA),and the skin and soft tissue defect was covered with bone marrow mud at the same time;Stage II:Patients with skin defects were repaired with pedicled skin flap or skin graft.After 6~8 weeks of wound healing,the placed bone cement spacer was removed and treated with autologous bone transplantation combined with Ilizarov Mini Fixator external fixation.Patients with infection bone defect:Stage I radical debridement and PMMA filling bone defect.Those with skin and soft tissue defects or poor skin and soft tissue conditions should repair the wound.Period protocol was the same as traumatic bone defect.All patients were given symptomatic treatment such as preventing or controlling infection,observing the blood supply of affected fingers(limbs)and flaps,and functional rehabilitation training was conducted in the early stage(2 weeks).Results Seventeen cases were followed up for 5~29 months.All the grafts healed,mean healing time 11.9 weeks(10.5-14.0weeks).There were no complications such as wound infection and flap necrosis.16 wounds healed in Grade A,1 case delayed.The excellent healing rate of bone grafting was 82.35%.17 cases were followed up for 5~28 months after stage II operation.After fracture healing and rehabilitation,the hand function was evaluated,which was excellent in 5 cases,good in 8 cases and fair in 4 cases.The excellent and good rate was 70.47%.

关 键 词：改良 Masquelet技术 大段 掌指骨骨缺损 Ilizarov Mini-Fixator 

分 类 号：R687.3[医药卫生—骨科学]