Masquelet技术与Ilizarov技术治疗成人胫骨慢性骨髓炎的早期临床疗效比较

目的 比较Masquelet技术与Ilizarov技术治疗成人胫骨慢性骨髓炎清创后大段骨缺损的早期临床疗效.方法 回顾性分析2011年1月至2015年5月我院收治的45例成人胫骨慢性骨髓炎病人资料,Masquelet技术治疗的27例纳入Masquelet组,男20例,女7例,骨缺损长度为(8.9±2.2)cm;Ilizarov技术治疗的18例纳入Ilizarov组,男12例,女6例,骨缺损长度为(8.3±2.1)cm.收集并比较两组病例的骨愈合时间、完全负重时间、术后并发症情况及末次随访时的Iowa膝关节评分、Iowa踝关节评分、SF-36量表得分.结果 45例病人的随访时间为12～38个月,平均(21.5±6.5)个月.Masquelet组与Ilizarov组的骨愈合时间分别为(20.85±4.31)周、(28.86±6.47)周,完全负重时间分别为(23.17±6.93)周、(32.87±6.79)周,两组间比较,差异均有统计学意义(t=4.944,P<0.0001;t=4.636,P<0.0001);两组末次随访时的Iowa膝、踝关节评分及SF-36量表总得分均较术前明显改善,但两组间比较,差异均无统计学意义(P均>0.05).结论 Masquelet技术与Ilizarov技术均可有效地解决成人胫骨慢性骨髓炎清创后大段骨缺损问题,但Masquelet技术能显著缩短治疗周期,完全负重时间早,是一种简单有效的手术方法.

Comparison of early clinical effect of Masquelet technique vs. Ilizarov technique in the treatment of adult chronic osteomyelitis of tibia

Objective To compare the clinical curative effects of Masquelet technique vs. Ilizarov technique in the treatment of large bone defects after debridement with chronic osteomyelitis of tibia in adult pa-tients. Methods A retrospective analysis of 45 cases of adult chronic osteomyelitis of tibia in our hospital from January 2011 to May 2015 was performed. Twenty-seven cases treated by Masquelet technique were included in the Masquelet group including 20 males and 7 females, and the length of bone defect was (8.9±2.2) cm, while 18 cases treated by Ilizarov technique were included in the Ilizarov group including 12 males and 6 females, and the length of bone defect was (8.3±2.1) cm. The bone healing time, weight-bearing time, complications, Iowa knee score, Iowa ankle score and SF-36 scale score were collected and compared between the two groups. Results Forty-five patients were followed up for 12-38 months, with an average of (21.5 ± 6.5) months. The bone healing time in Masquelet group and Ilizarov group was (20.85±4.31) weeks and (28.86±6.47) weeks, and weight-bearing time was (23.17±6.93) weeks and (32.87±6.79) weeks respectively, with the differences between the two groups being statistically significant (t=4.944, P<0.0001; t=4.636, P<0.0001). The Iowa scores of knee and ankle joint, and SF-36 score in the two groups at the last follow-up were significantly improved as com-pared with those preoperation, but there was no significant difference between the two groups (P>0.05 for all). Conclusion Masquelet technique and Ilizarov technique could solve the problem of chronic osteomyelitis after debridement of adult tibial large bone defect, but Masquelet technique could significantly shorten the treatment period and weight-bearing time, and is a simple and effective surgical method.