Masquelet技术治疗胫骨慢性骨髓炎合并骨缺损的疗效分析

  目的  观察Masquelet技术用于治疗胫骨慢性骨髓炎合并骨缺损的临床效果及安全性。  方法  以2018年5月—2021年10月于杭州师范大学附属医院骨科就诊并接受Masquelet技术治疗的5例胫骨慢性骨髓炎合并骨缺损患者为研究对象，随访至术后6个月，比较患者美国特种外科医院膝关节功能评分(HSS)、美国足踝外科协会踝与后足功能评分标准(AOFAS)、健康调查简表(SF-36)评分变化情况，通过影像学检查确认胫骨缺损病灶愈合情况，观察患者术后并发症发生情况。  结果  全部5例患者治疗前HSS评分为32~38(35.60±2.61)分，AOFAS评分为33~42(38.40±3.42)分，SF-36评分为35~40(38.40±2.07)分。术后6个月经复查，患者缺损病灶骨均愈合良好，HSS评分为83~90(85.80±2.68)分，AOFAS评分为84~89(86.20±2.17)分，SF-36评分为83~90(85.40±2.70)分，均较治疗前升高(t=66.893、52.802、57.346，均P＜0.001)。除1例患者由于取骨切口感染而导致延迟拆线外，其余患者均未出现术后并发症。  结论  Masquelet技术用于治疗胫骨骨髓炎所致大范围骨缺损具有较高的有效性和安全性，对于改善患者下肢运动功能和生存质量具有积极意义，值得临床推广。 

Study on the clinical effect of Masquelet technique on tibial chronic osteomyelitis and bone defect

  Objective  To observe the clinical effect and safety of Masquelet technique in the treatment of tibial chronic osteomyelitis and bone defect.  Methods  Five patients with chronic osteomyelitis and bone defects in the tibia treated by Masquelet technology in the Department of Orthopaedics of our hospital from May 2018 to October 2021 were examined. They were followed up to 6 months after operation. Changes in hospital for special surgery (HSS), American orthopedic foot and ankle society (AOFAS) and the MOS item short from health survey (SF-36) scores were compared, the healing of tibial defect lesions was confirmed by imaging examination and the postoperative complications were observed.  Results  Before treatment, the HSS scores was 32-38 (35.60±2.61) points, the AOFAS score was 33-42 (38.40±3.42) points, the SF-36 score was 35-40 (38.40±2.07) points. After six menstrual reexaminations, all patients had good bone healing, the HSS score was 83-90 (85.80±2.68) points, the AOFAS score was 84-89 (86.20±2.17) points, the SF-36 score was 83-90 (85.40±2.70) points, which was significantly higher than that before treatment (t=66.893, 52.802, 57.346; all P < 0.001). Except one patient with delayed suture removal due to infection of bone incision, other patients did not have postoperative complications.  Conclusion  Masquelet technology is highly effective and safe in the treatment of large-scale bone defects caused by tibial osteomyelitis. It has positive significance for improving the lower limb motor function and quality of life of patients, and is worthy of clinical promotion.