Masquelet技术结合游离髂腹股沟皮瓣重建掌骨骨折术后感染性骨和软组织缺损16例  

Masquelet technique with transfer of free iliac inguinal flap in reconstruction of infectious bone and soft tissue defect after metacarpal fracture surgery: a report of 16 cases

作　　者：董俊文 梁高峰 张朝 智丰 权小波 贾宗海 程永涛 段超鹏 滕云升 郭永明 DONG Junwen;LIANG Gaofeng;ZHANG Chao;ZHI Feng;QUAN Xiaobo;JIA Zonghai;CHENG Yongtao;DUAN Chaopeng;TENG Yunsheng;GUO Yongming(Department of Hand Surgery,Institute for Hygiene of Ordnance Industry(Weapon Industry 521 Hospital),Xi'an 710065,China)

机构地区：[1]兵器工业卫生研究所(兵器工业五二一医院)手外科,西安710065

出　　处：《中华显微外科杂志》2023年第4期383-390,共8页Chinese Journal of Microsurgery

基　　金：陕西省重点研发计划(2022SF-016)。

摘　　要：目的:探讨Masquelet技术结合游离髂腹股沟皮瓣重建掌骨骨折术后感染性骨和软组织缺损的临床疗效。方法:2014年1月至2020年1月,兵器工业卫生研究所(兵器工业五二一医院)手外科对16例掌骨骨折术后感染性骨和软组织缺损患者采用急诊清创负压封闭引流(VSD)敷料覆盖创面,亚急诊行Masquelet技术结合游离髂腹股沟皮瓣分阶段重建掌骨感染性骨缺损,其中男14例,女2例,年龄20~50(平均38)岁。10例取出钢板,6例保留钢板,掌骨骨缺损的体积为0.8 cm×0.8 cm×2.0 cm~1.5 cm×2.0 cm×5.1 cm,软组织缺损面积3.6 cm×6.8 cm~7.8 cm×11.6 cm,16例均存在肌腱缺损。Masquelet技术第1阶段术后常规预防感染、抗凝血、抗痉挛等治疗。每隔2周随访1次,排除感染后采用Masquelet技术第2阶段自体颗粒松质骨植骨重建掌骨骨缺损,术后预防感染等治疗,每隔1~2周随访1次,骨折愈合后每隔2~4个月随访1次。随访内容包括:伤口有无感染,皮瓣有无坏死及皮瓣外形、纹理、质地及皮瓣感觉恢复情况;X线片评价掌骨感染性骨缺损骨愈合情况,观察有无感染复发、骨吸收及骨不连情况;采用中华医学会手外科学会上肢部分功能评定试用标准评价手功能;观察皮瓣供区愈合情况,了解皮瓣供区有无不适以及是否影响行走等。结果:本组16例均获得随访,随访时间1.5~3.0(平均2.4)年,16例髂腹股沟皮瓣均无皮瓣坏死发生,无感染复发,皮瓣愈合良好。16例患者皮瓣外形、纹理及质地与邻近的皮肤接近。髂腹股沟皮瓣的两点辨别觉(TPD)为8~10 mm。X线片示16例掌骨感染性骨缺损均获骨性愈合,骨愈合时间为植骨术后2.1~3.4(平均2.9)个月,无骨吸收、感染、骨不连发生。手功能按中华医学会手外科学会上肢部分功能评定试用标准评定,优13例,良3例。皮瓣供区均I期愈合,供区髋部运动功能均未受影响。结论:Masquelet技术结合游离髂腹股沟皮瓣重建掌Objective To investigate the clinical effects of Masquelet technique with the transfer of free iliac inguinal flap in reconstruction of infectious bone and soft tissue defect after metacarpal fracture surgery.Methods From January 2014 to January 2020,16 patients suffered from infectious bone and soft tissue defect after surgery of metacarpal fracture were treated in Department of Hand Surgery,Institute for Hygiene of Ordnance Industry(Weapon Industry 521 Hospital).Debridement and vacuume sealing drainage(VSD)coverage of wound were carried out in emergency surgery,and Masquelet technique combined with free iliac inguinal flap for reconstruction of infected metacarpal bone defect were performed in sub-emergency surgery.The patients were 14 males and 2 females with an average age of 38(20-50)years old.Plates were removed in 10 patients and retained in 6 patients.Defects of metacarpal bone ranged from 0.8 cm×0.8 cm×2.0 cm to 1.5 cm×2.0 cm×5.1 cm in size.Soft tissue defects ranged from 3.6 cm×6.8 cm to 7.8 cm×11.6 cm.Tendon defects were found in all 16 patients.After the primary procedure of Masquelet technique combined with free iliac inguinal flap,routine anti-infection,anticoagulant,antispasmodic and other treatments were offered to all patients.Then all patients were observed by fortnightly reviews.After infection was cleared,the second phase of Masquelet treatment began.The defects of metacarpal bone were reconstructed with autologous cancellous bone grafts,and measures to prevent from infection together with other therapies were offered after the surgery.Follow-up of the second phase surgery was carried out once per 1-2 weeks and then per 2-4 months after bone union.The follow-up review items included:wound infection and necrosis,appearance,shape,texture and sensory recovery of flap.Bone union of infectious metacarpal defect was evaluated,recurrence of infection was closely observed as well as the resorption or nonunion of bone by X-rays.Hand function was assessed according to the Evaluation Trial Standard

关 键 词：掌骨骨折 Masquelet技术 髂腹股沟皮瓣 感染性骨缺损 软组织缺损 

分 类 号：R687.3[医药卫生—骨科学]