Masquelet技术联合富血小板血浆修复胫骨大段骨缺损

目的探讨Masquelet技术联合富血小板血浆(PRP)修复胫骨大段骨缺损的疗效。方法采用前瞻性随机对照单盲方法选取佛山市中医院修复重建外科2016年6月至2018年6月收治的21例胫骨大段骨缺损患者,骨缺损长度为6.0~22.5 cm(平均10.8 cm)。男14例,女7例;年龄29~60岁,平均42.1岁。采用随机数字表加密封信法,单数为试验组,双数为对照组:试验组11例,采用Masquelet技术联合PRP进行骨缺损重建;对照组10例,采用Masquelet技术进行骨缺损重建。比较两组患者第二阶段的手术时间、住院时间及伤口愈合情况以及第二阶段术后两组患者的负重时间、骨性愈合时间、临床愈合时间、并发症的发生情况及Johner-Wruhs评分。结果试验组与对照组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获12~24个月(平均14.9个月)随访。两组患者第二阶段的手术时间、住院时间、伤口愈合情况、负重时间、Johner-Wruhs评分、并发症发生率比较,差异均无统计学意义(P>0.05)。试验组的骨性愈合时间、临床愈合时间分别为(4.5±1.2)、(4.1±0.9)个月,均短于对照组的(5.7±1.5)、(5.4±1.1)个月,差异有统计学意义(P<0.05)。试验组患者未发现明显术后感染、内固定物松动、骨吸收、骨不连等并发症;对照组出现1例伤口感染患者,予换药后好转。结论Masquelet技术联合PRP可有效修复胫骨大段骨缺损,提高骨愈合速度,是一种安全、有效的治疗方法。

Masquelet technique combined with platelet-rich plasma to repair massive tibial defects

Objective To investigate the effect of Masquelet technique combined with platelet-rich plasma(PRP)on repair of massive tibial defects.Methods A prospective randomized controlled single blind trial was conducted in the 21 patients who had been admitted to Department of Repair and Reconstruction Surgery,Foshan Hospital of Chinese Medicine for massive tibial defects from June 2016 to June 2018.The length of bone defects ranged from 6.0 to 22.5 cm(mean,10.8 cm)in length.They were 14 males and 7 females,aged from 29 to 60 years(mean,42.1 years).The patients were divided into 2 groups by an en-crypting envelope with a random digital table.In the experimental group of 11 cases,the bone defects were repaired with Masquelet technique combined with PRP;in the control group of 10 cases,the bone defects were reconstructed with only Masquelet technique.The 2 groups were compared in terms of operation time,hospital stay,wound healing,weight-bearing time,bony union time,clinical union time,complications and John-er-Wruhs scores at the second stage.Results The 2 groups were comparable due to insignificant differ-ences between them in the preoperative general data(P>0.05).All patients were followed up for 12 to 24 months(mean,14.9 months).There were no significant differences in operation time,hospital stay,wound healing,weight-bearing time,Johner-Wruhs scores or rate of complications at the second stage between the 2 groups(P>0.05).The bony union time(4.5 months±1.2 months)and clinical union time(4.1 months±0.9 months)in the experimental group were significantly shorter than those(5.7 months±1.5 months and 5.4 months±1.1 months)in the control group(P<0.05).No such postoperative complications as infection,loosening of internal fixator,bone resorption or nonunion were found in the experimental group.One case of wound infection occurred in the control group but responded to dressing change.Conclusion Masquelet technique combined with PRP is a safe and effective reparative treatment for massive tibial defects and can speed up bone healing.