Masquelet技术二期髓内钉固定重建术治疗胫骨感染性骨缺损

目的探讨Masquelet技术二期髓内钉固定重建术治疗胫骨感染性骨缺损的临床疗效。方法回顾性分析2013年6月至2017年12月我院应用Masquelet技术行二期髓内钉固定重建术治疗的53例胫骨感染性骨缺损患者的临床资料。所有患者在一期清创术后应用抗生素骨水泥填塞骨缺损并稳定断端,二期手术取出抗生素骨水泥,更换固定器械为髓内钉,诱导膜内充分植骨。随访观察术后感染复发率、骨愈合率及并发症发生情况。结果所有患者术后随访15~66个月,平均(46.3±11.5)个月,均无感染复发、轴线偏移、再骨折现象。51例(96.2%)骨愈合;2例(3.8%)出现肥大性骨不连,翻修辅助重建锁定钢板后均愈合;1例(1.9%)出现髂后供骨区切口感染。结论胫骨感染性骨缺损应用Masquelet技术二期髓内钉固定重建术可获得良好的临床疗效,具有增加稳定性、减少植骨量、避免轴线偏移等优势。

Masquelet technique for reconstruction of infected tibial defects with intramedullary nail in the second stage

Objective To evaluate the clinical effect of Masquelet technique for reconstruction of infected tibial bone defect with intramedullary nail in the second stage.Methods The clinical data of 53 patients suffered with infected tibial bone defect from June 2013 to December 2017 in our hospital were retrospectively analyzed.In the first stage,the defects were stabilized with antibiotic-loaded bone cement after debridement.In the second stage,the antibiotic cement was removed,the fixation instrument was replaced by intramedullary nail,with adequate bone grafting.The recurrence of infection,bone healing and complications were observed.Results All patients were followed up for 15~66 months,with an average of(46.3±11.5)months,no recurrence of infection,axis deviation nor re-fracture was found.Among all patients,51 patients(96.2%)had bone union,2 patients(3.8%)had hypertrophic nonunion,who were treated by revision combined with reconstructive locking plate,and 1 patient(1.9%)had incision infection in the posterior iliac donor site.Conclusion Masquelet technique for reconstruction of infected tibial bone defect with intramedullary nail in the second stage has a good clinical effect,which has the advantages of enhancing stability,reducing bone graft volume and avoiding axis deviation.