诱导膜技术联合双钢板治疗胫骨骨干大段骨缺损△

Membrane induction technique combined with double-plate internal fixation for large segment bone defect of tibial shaft

摘要:

［目的］ 介绍诱导膜技术 （Masquelet） 联合双钢板固定胫骨骨干大段骨缺损的手术技术和初步效果。［方法］ 2016 年 1 月—2019 年 1 月，采用诱导膜技术联合双钢板固定 18 例胫骨骨干大段骨缺损患者。术前评估畸形，胫骨骨缺损部彻底清创，控制感染后填塞骨水泥，并同时覆盖创面，必要时皮瓣修复。待诱导膜形成后，去除骨水泥，缺损处植骨，同时从同一切口行胫骨内、外侧钢板固定后关闭切口。［结果］18 例患者均顺利完成手术，无严重并发症。除 2 例患者伤口浅部感染，通过增加换药次数、使用抗感染药物后愈合，其余患者均在二期术后创面愈合良好。术后随访 12 个月以上，临床骨愈合时间为 （4.44±0.98） 个月。末次随访患者 VAS 评分、Lowa 膝关节功能评分、Lowa 踝关节功能评分较术前均显著改善 （P<0.05）。［结论］ 诱导膜技术联合双钢板可有效治疗胫骨骨干大段骨缺损，术后愈合良好，具有操作简单、患者接受度高、并发症少等优点。

Abstract:

[Objective] To introduce the surgical technique and preliminary results of membrane induction (Masquelet technique) com- bined with double-plate internal fixation for large segmental bone defect of tibial shaft. [Methods] From January 2016 to January 2019, 18 patients with tibial diaphysis defect were treated with induction membrane technique combined with double-plate internal fixation. The de- formity was evaluated before surgery, and the defect of tibia bone was thoroughly debrided. After infection control, bone cement was filled and the wound was covered at the same time, skin flap was used if necessary. After the membrane induced was formed properly, the bone ce- ment was removed and bone grafting was performed at the defect site, simultaneously, internal fixation with lateral and medial plates in the same incision was conducted. [Results] All the 18 patients were successfully operated on without serious complications. Except 2 patients who had postoperative superficial wound infection, which healed after dressing change and using anti-infective drugs, all the patients got sound wound healing after the second-stage operation. All the patients were followed up for more than 12 months, and got clinical bone healing in (4.44±0.98) months. At 12 months postoperatively the VAS score, Lowa knee function score and Lowa ankle function score signif- icantly improved compared with those preoperatively (P＜0.05) . [Conclusion] This membrane induction technique combined with doubleplate for internal fixation does effectively treat the large-segment bone defect of tibial shaft with good clinical outcomes, and has the advan- tages of simple operation, high acceptance by patients, and few complications.