Masquelet技术联合内固定分期治疗股骨转子下感染性骨不连  

Masquelet technique combined with internal fixation in the treatment of infected subtrochanteric nonunion of femur by stages

作　　者：谢云飞 厉孟 鲁笑天 苏一桐 罗想利[2] XIE Yun-fei;LI Meng;LU Xiao-tian;SU Yi-tong;LUO Xiang-li(First Clinical College of Gansu University of Traditional Chinese Medicine,Lanzhou,Gansu,730099,China)

机构地区：[1]甘肃中医药大学第一临床学院,兰州730099 [2]甘肃省人民医院骨三科,兰州730099

出　　处：《中国骨与关节杂志》2025年第3期193-199,共7页Chinese Journal of Bone and Joint

基　　金：甘肃省自然科学基金项目(24JRRA1046)。

摘　　要：目的探讨Masquelet技术(膜诱导技术)与内固定结合的分期疗法对股骨转子下感染性骨不连患者的有效性。方法回顾分析2020年5月至2023年5月甘肃省人民医院收治并获完整随访的8例成人股骨转子下骨折内固定术后感染性骨不连患者资料,其中男6例,女2例;年龄48~67岁,平均(52.6±4.3)岁。病程8~76个月,平均(27.2±11.3)个月。骨折按Seinsheimer类型:ⅢA型2例,ⅢB型1例,Ⅳ型4例,Ⅴ型1例;原内固定方式:髓内系统固定6例,钢板固定2例。所有患者都经过膜诱导技术的两阶段处理接受治疗:第一阶段(Ⅰ期)去除原内固定物并彻底清创,缺损区植入抗生素骨水泥,锁定加压钢板(locking compression plate,LCP)固定;第二阶段(Ⅱ期)去除抗生素骨水泥,采用LCP和(或)髓内钉稳固断端并植骨。通过白细胞计数(white blood cell count,WBC)、降钙素原(procalcitonin,PCT)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reaction protein,CRP)评估患者Ⅰ期和末次随访时感染控制情况,记录骨性愈合时间,末次随访时根据Samantha X线评分及Paley骨性评分标准评价骨愈合情况、通过视觉模拟评分(visual analogue scale,VAS)及Sanders髋关节创伤后评分评价患肢功能恢复情况。结果8例患者术后获随访12~32个月,平均(21.6±10.3)个月。1例Ⅰ期术后感染复发,再次清创后得到有效控制,在随访期间再无复发,Ⅰ期控制感染率为87.5%(7/8)。8例患者在随访期间均未发生切口破溃、渗液、感染复发、骨不连和下肢静脉血栓。末次随访时WBC[(6.50±1.03)×10^(9)/L vs.(12.67±0.43)×10^(9)/L]、ESR[(6.25±1.08)mm/h vs.(32.31±4.66)mm/h]、PCT[(0.44±0.15)ng/ml vs.(13.28±1.50)ng/ml]、CRP[(3.09±0.47)mg/L vs.(14.48±0.95)mg/L]较术前改善明显,差异均有统计学意义(P<0.05);Samantha X线评分为4~6分,平均4.9分,VAS评分为0~3分,平均1.6分。Sanders髋关节创伤后评分标准评定疗效:优6例、良1例、可1例,根�Objective To investigate the effectiveness of Masquelet technique combined with internal fixation for patients with subtrochanteric bone nonunion.Methods The data of 8 adult patients with infected bone nonunion after internal fixation of subtrochanteric fracture treated in Gansu Provincial People’s Hospital from May 2020 to May 2023 were retrospectively analyzed,including 6 males and 2 females.The age ranged from 48 to 67 years,with a mean of(52.6±4.3)years.The course of disease ranged from 8 to 76 months,with an average of(27.2±11.3)months.According to the Seinsheimer type,there were 2 cases of ⅢA type,1 case of ⅢB type,4 cases of Ⅳ type and 1 case of Ⅴ type.The original internal fixation methods included intramedullary system fixation in 6 cases and plate fixation in 2 cases.All patients were treated in a two-stage treatment with membrane induction technology.PhaseⅠ:Removalof the original internal fixator and complete debridement,implantation of antibiotic bone cement in the defect area,and fixation with lockingcompressionplate(LCP);Phase Ⅱ:The antibiotic bone cement was removed,and the fracture end was stabilized with LCP and/or intramedullary nail and bone grafting was performed.Use the white blood cell count(WBC),procalcitonin(PCT),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)to assessed patients’infection control at stage Ⅰ and the final follow-up,and record bone healing time.Bone healing was evaluated by SamanthaX line score and Paley bone score at the last follow-up.Functional recovery of affected limb was evaluated by visual analogue scale(VAS)and Sanders score after hip injury.Results 8 patients were followed up for 12 to 32 months,with an average of(21.6±10.3)months.The infection recurred after the operation of stage Ⅰ in one case,which was effectively controlled after the second debridement.During the follow-up period,there was no recurrence,and the infection rate of stage Ⅰ was 87.5%(7/8).No incision rupture,effusion,infection recurrence,bone nonunion,or veno

关 键 词：股骨骨折 骨折 不愈合 内固定器 膜诱导技术 

分 类 号：R681.2[医药卫生—骨科学]