骨髓间充质干细胞结合Masquelet技术治疗感染性骨缺损的临床疗效观察

目的 观察应用骨髓间充质干细胞（bone marrow mesenchymal stem cells，BMSCs）结合Masquelet技术治疗感染性骨缺损的临床疗效。方法 回顾性分析2016年6月至2019年1月河南省洛阳正骨医院采用BMSCs结合Masquelet技术治疗的30例感染性骨缺损病人的临床资料。其中男21例，女9例；年龄为20~65岁，平均34.5岁。缺损部位：胫骨干18例，尺、桡骨干6例，股骨干5例，肱骨干1例。骨缺损长度为3~13 cm，平均7.3 cm。车祸伤23例，机器挤压伤4例，高处坠落伤3例。手术分两个阶段进行，第一阶段彻底清创，清除感染坏死骨组织和软组织及血供较差的瘢痕组织、填充骨水泥间隔并覆盖伤口，固定骨折；第二阶段于第一次手术后8~10周去除骨水泥间隔，在其诱导形成的诱导膜内行BMSCs结合自体骨与人工骨移植填充。记录所有病人骨折愈合时间，末次随访时使用Johner-Wruhs评分标准对骨缺损愈合情况进行评价。结果 病人随访8~25个月，平均15.5个月。其中28例病人术后平均9.4个月（6~15个月）骨缺损获得影像学和临床愈合。1例术后感染复发，重复应用诱导膜技术后愈合。1例术后12个月时复查显示骨折愈合不全，再次行取髂骨补充植骨术后愈合。根据Johner-Wruhs评分标准，优27例，良2例，可1例，优良率为96.7%。结论 采用BMSCs结合Masquelet技术治疗感染性骨缺损效果良好，是一种可行的治疗方法。

Effectiveness of Bone Marrow Mesenchymal Stem Cells Combined with Masquelet Technique in the Treatment of Infectious Bone Defect

Objective To observe the clinical effectiveness of bone marrow mesenchymal stem cells (BMSCs) combined with Masquelet technique in the treatment of infectious bone defect. Methods From June 2016 to January 2019, 30 patients with infectious bone defect were treated with BMSCs combined with Masquelet technique. In the first stage, the infected and necrotic bone tissue, soft tissue and scar tissue with poor blood supply were removed, the bone cement interval was filled, the wound was covered, and the fracture was fixed. In the second stage, the bone cement interval was removed 8-10 weeks after operation, and the induced membrane was filled with BMSCs combined with autologous bone and artificial bone graft. The fracture healing time of all patients was recorded, and the Johner-Wruhs scoring system was used to evaluate the bone defect healing at the last follow-up. Results All patients were followed up for 8-25 months (mean 15.5 months). The average time of bone defect healing was 9.4 (6-15) months in 28 patients. One case of postoperative infection relapsed and healed after repeated application of induced membrane technique. One case showed incomplete fracture healing after 12 months of reexamination, and healed after the second iliac bone graft. According to Johner-Wruhs scoring system, 27 cases were excellent, 2 cases were good, 1 case was fair, and the excellent and good rate was 96.7%. Conclusion BMSCs combined with Masquelet technique are effective in the treatment of infectious bone defect, which is a feasible method.