Masquelet技术结合游离皮瓣移植技术在手部软组织伴掌骨缺损中的可行性及临床疗效  

The feasibility and clinical efficacy of Masquelet technique combined with free flap transplantation in the treatment of hand soft tissue defects with metacarpal bone defects

作　　者：张松 陈步国 唐兆麟 孙传伟 吴尧 王瑞帅 朱辉 Zhang Song;Chen Buguo;Tang Zhaolin;Sun Chuanwei;Wu Yao;Wang Ruishuai;Zhu Hui(Department of Hand Surgery,Xuzhou Renci Hospital,Xuzhou 221004,China)

机构地区：[1]徐州仁慈医院手外科,徐州1221004

出　　处：《中华手外科杂志》2024年第5期426-430,共5页Chinese Journal of Hand Surgery

摘　　要：目的 探讨Masquelet技术下结合游离皮瓣移植技术治疗手部软组织伴掌骨缺损的可行性及临床疗效.方法 自2021年1月至2023年3月,我们采用Masquelet技术结合游离皮瓣移植技术修复6例创伤性手部软组织伴掌骨缺损的患者,急诊彻底清创后,骨水泥填塞包裹掌骨缺损断端、异种皮或负压封闭引流(vacuum sealing drainage,VSD)临时覆盖创面,术后1~2周更换骨水泥,游离皮瓣移植修复手背创面.股前外侧皮瓣移植修复2例,其中1例行双侧股前外侧皮瓣修复;腓肠内侧动脉穿支皮瓣移植修复3例;旋髂浅动脉穿支皮瓣移植修复1例.术后3.0~6.9个月,5例行自体髂骨植骨修复(6侧),1例行髂骨瓣修复.结果 术后随访时间为9~30个月,平均22.3个月,所有皮瓣均存活,植骨愈合时间平均3.2个月,1例供体部位伤口愈合不良,换药后愈合.取髂骨部位的供体视觉模拟评分(visual analogue scale,VAS)平均1.4分,手功能根据中华医学会手外科学会上肢部分功能评定试用标准评价:优4例,良1例,可1例.结论 Masquelet技术结合游离皮瓣在治疗手部软组织伴掌骨缺损中,Masquelet技术促进骨愈合,未并发1例骨髓炎,皮瓣修复创面,两技术结合手术安全、效果满意,该技术是治疗手部软组织伴掌骨缺损的一个可行治疗方案.Objective To investigate the feasibility and clinical efficacy of Masquelet technique combined with free flap transplantation in the treatment of hand soft tissue defects with metacarpal bone defects.Methods From January 2021 to March 2023,6 cases of patients with traumatic hand soft tissue and metacarpal defects were repaired by Masquelet technique combined with free flap transplantation.After thorough debridement in the emergency department,bone cement was used to wrap the broken end of the metacarpal bone defects,and xenograft skin or vacuum sealing drainage(VSD)was used to temporarily cover the wound.Bone cement was replaced 1 to 2 weeks after surgery,and free skin flap transplantation was used to repair the wound in the dorsal hand.The anterior lateral femoral skin flap transplantation was applied in 2 cases,of which one case was repaired with bilateral anterior lateral femoral skin flap.The medial sural artery perforator flap transplantation was applied in 3 cases.The superficial iliac artery perforator flap transplantation was applied in 1 case.From 3.0 to 6.9 months after surgery,5 cases underwent autologous iliac bone grafting repair(6 sides),and 1 case underwent iliac bone flap repair.Results The postoperative follow-up time was 9 to 30 months,with an average of 22.3 months.All skin flaps survived and the average bone graft healing time was 3.2 months.One donor site wound healed poorly and healed after dressing change.The average visual analogue scale(VAS)of the donor at the iliac bone site was 1.4 points.The hand function was evaluated according to the trial criteria of the Chinese Society of Hand Surgery for upper limb function.The results were excellent in 4 cases,good in I case,and fair in I case.Conclusion In the Masquelet technique combined with free skin flap in the treatment of hand soft tissue accompanied by metacarpal bone defects,Masquelet technique can promote bone healing and no case of osteomyelitis occurred.The skin flap can repaire the wound,and the combination of the two techniques is s

关 键 词：手损伤 外科皮瓣 Masquelet技术 骨缺损 骨水泥 

分 类 号：R658.2[医药卫生—外科学]