Masquelet技术治疗下肢长骨骨缺损的肢体功能障碍分析

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摘要目的分析Masquelet技术治疗下肢长骨骨缺损所致肢体功能障碍原因。方法对2012年1月至2019年3月北部战区总医院收治的52例下肢长骨骨缺损临床资料进行回顾性病例系列研究分析。其中男43例，女9例；年龄15～73岁，平均(36.7±4.5)岁。原始受伤原因：交通伤28例，重物砸伤4例，摔伤11例，高处坠落伤2例，军事训练伤3例，骨肿瘤3例，骨髓炎1例。病变部位：胫骨28例，股骨22例，腓骨2例。均采用Masquelet诱导膜技术分期治疗。Ⅰ期彻底清创、微生物学检查、抗生素骨水泥占位，Ⅱ期在6～8周后植骨。术后采用Paley骨折愈合评分标准和X线片对下肢功能及骨折愈合情况进行评价。结果全部患者术后获得12～92个月随访，平均(41.9±6.7)个月。47例获得骨性愈合。按Paley骨折愈合评分标准进行评价，优31例，良9例，可7例，差5例，优良率达76.9%。1例骨折愈合取出内固定后再次出现骨髓炎复发，仍在治疗中。1例浅部感染，通过换药方式获得痊愈。1例植骨后感染再次复发，经清创后再次诱导膜、植骨后愈合。2例出现植骨区骨重塑欠佳，2例植骨感染复发行截肢术。2例患者植骨后再次出现深部感染，因无法恢复正常活动，需要助行器辅助行走。3例活动后膝关节轻微疼痛，1例出现轻微下蹲痛，7例膝关节活动度0°～45°，3例膝关节活动度0°～90°，1例行踝关节融合，2例踝关节轻度屈伸受限。结论 Masquelet诱导膜技术治疗下肢长骨骨缺损可促进骨折愈合，恢复肢体功能，减少并发症。骨干部骨缺损的延迟治疗、干骺端骨缺损固定时间长是关节活动受限的主要原因。

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关键词 ： Masquelet技术, 下肢骨折, 骨缺损, 功能障碍

Abstract：Objective To evaluate dysfunction of induced membrane technique for restoration of long bone segmental defect for differentreasons.Methods A retrospective case series analysis was made from January 2012 to March 2019.Fifty-two patients (43 males，9 females)met the inclusion criteriawith a mean age of (36.7±4.5)years (range，15~73 years) admitted in General Hospital of Northern Theater Command.According to intial injury，there were 28 cases of traffic accident，4 cases of bruise injury caused by heavy object，11 cases of fall，2 cases of falling accident from high place，3 cases of military training injury，3 cases of bone tumor，and 1 case of osteomyelitis.According to the lesion sites，there were 22 cases of femur，28 cases of tibia and 2 cases of fibula.Masquelet technique was performed including phase Ⅰsurgical debridement，microbiology cultures and antibiotics-loaded bone cement impregnation to induce a membrane.Bone defect reconstruction was done by intramembranous bone grafting At phase Ⅱ，6~ 8 weeks after phase Ⅰ.Paley bone union evaluation system andX-ray films were observed during follow-up periods.Results All patients were followed up for (41.9±6.7) months (range，12~ 92 months).There were 47 cases obtained one-stage bone healing.31 cases were excellent，9 cases were good，7 cases were fair and 5 cases were poor according to Paley bone union evaluation system.The total effective rate was 76.9 percent.One case of osteomyelitis recurred after internal fixation removal，still under treatment.One case required debridement due to superficial infection.One case required to be treated by induced membrane technique again due to recurrence.Two cases poor existed as bone remodeling in bone graft area.Two cases underwent amputation because of recurrence.Two cases recurred because of deep infection，they could not return to normal activities and needed walking aids.The knee joint was slightly painful in three patients after exercise.One patient presented with mild squatting pain，seven patients presented with 0°~ 45° degree of motion of the knee joint，three patients presented with 0°~ 90° degree of motion of the knee joint.One underwent ankle fusion，and two patients presented with mild ankle flexion and extension limitation.Conclusion Masquelet induced membrane technique could promote fracture healing，restore limb function and reduce complications.Delayed treatment of diaphyseal bone defect and long fixation time of epiphyseal bone defect are the main reasons for limited joint movement.

Key words： Masquelet technique lower limb fracture bone defect dysfunction

基金资助:2014年度全军后勤科研计划(AWS14C003)
辽宁省自然科学基金(20180551082)

通讯作者: 周大鹏

作者简介: 纪振钢(1974－ )，男，副主任医师，北部战区总医院骨科，110016。

引用本文:

纪振钢，周大鹏 *，韩天宇，赵勇，刘兵，薛海鹏，解冰，张昊，宋夏楠. Masquelet技术治疗下肢长骨骨缺损的肢体功能障碍分析[J]. 实用骨科杂志, 2020, 26(7): 600-604.
Ji Zhengang，Zhou Dapeng *，Han Tianyu，et al. Dysfunction Analysis of Masquelet Technique for the Treatment of Long Bone Segmental Defects of Lower Limb. sygkzz, 2020, 26(7): 600-604.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I7/600

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