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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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

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