Masquelet技术治疗慢性骨髓炎后大段骨缺损的早期临床疗效

发布时间：2018-04-12 22:00

本文选题：Masquelet技术 + 慢性骨髓炎　；参考：《浙江大学》2015年硕士论文

【摘要】：目的：探讨应用Masquelet技术治疗慢性骨髓炎后大段骨缺损的早期疗效。方法：回顾性分析2010年12月至2014年12月收治的4例慢性骨髓炎后大段骨缺损患者资料,男3例,女1例；年龄37-72岁,平均56.5岁。骨缺损长度5.4cm-11.2cm,平均7.1cm。所有患者均采用Masquelet技术分2个阶段治疗：第1阶段先要进行彻底的清创,外固定架或钢板外固定固定患肢,将混有10%万古霉素或泰能的聚甲基丙烯酸甲酯(PMMA)骨水泥塑形后填充于骨缺损部位,最后无张力关闭创面,第2阶段,切开并逐层分离软组织后,小心切开诱导膜,取出里面的骨水泥,然后在诱导膜腔里充填移植骨,逐层关闭。记录患肢术后并发症、骨愈合时间及功能情况。结果：所有患者术后获3-16个月(平均9个月)随访,切口4例愈合,无再发切口感染,无再发骨髓炎征象,无供区并发症,无术后再发骨折发生等需计划外手术。4例最终采用外固定架2例,钢板外固定2例,1例植骨中加入BMP。1例骨已愈合,患者影像学上示少许横向移位伴畸形愈合,未予特殊处理,功能良好,末次随访时,可完全负重行走,步态基本正常。1例影像学上骨已愈合,创口愈合良好,无疼痛,目前可拄拐部分负重行走。其余2例,影像学上可见骨痂生长,末次随访时,创口愈合良好,可拄拐部分负重行走,无疼痛。结论：Masquelet技术可以有效地治疗长骨慢性骨髓炎清创后大段骨缺损问题,具有操作简便、并发症少等特点。
[Abstract]:Objective: to investigate the early efficacy of Masquelet in the treatment of large bone defect after chronic osteomyelitis.Methods: the data of 4 patients with massive bone defect after chronic osteomyelitis from December 2010 to December 2014 were retrospectively analyzed, including 3 males and 1 female, with a mean age of 56.5 years (37-72 years).The length of bone defect was 5.4 cm to 11.2 cm, with an average of 7.1 cm.All patients were treated with Masquelet technique in two stages: stage 1, complete debridement, external fixation or plate fixation.The bone cement mixed with 10% vancomycin or tetracycline (PMMA) was molded and filled in the bone defect area. Finally, the wound was closed without tension. In the second stage, after cutting and separating the soft tissue layer by layer, the induction membrane was cut carefully.Take out the bone cement and fill in the induction chamber and close the graft layer by layer.Postoperative complications, bone healing time and function were recorded.Results: all the patients were followed up for 3-16 months (mean, 9 months). The incision healed in 4 cases, no recurrent wound infection, no sign of recurrent osteomyelitis, no complications in donor area.There were 2 cases of external fixator, 2 cases of external fixation, 2 cases of bone union with BMP.1 in 1 case of external fixation with steel plate, and a little lateral displacement with malunion on imaging, but no special treatment.The function was good. At the last follow-up, the body could walk with full load, and the gait was basically normal in 1 cases. The bone healed, the wound healed well, and there was no pain. At present, it was possible to walk with the aid of a crutch.The other 2 cases showed callus growth on imaging. At the last follow-up, the wound healed well and could walk on crutches partly with no pain.Conclusion: the technique of 10% Masquelet is effective in the treatment of large segment bone defect after debridement of chronic osteomyelitis of long bone, which has the advantages of simple operation and less complications.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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