摘要
目的探讨局部皮瓣转移修复足跟部软组织缺损联合3D打印个体化钛笼、Masquelet技术自体肋骨植骨治疗跟骨感染性缺损的有效性和安全性。方法回顾性分析2017年1月至2019年1月,采用局部皮瓣转移修复足跟软组织缺损和3D打印个体化钛笼、Masquelet技术自体肋骨植骨等技术治疗5例跟骨感染性骨缺损的患者资料,男3例,女2例;年龄37.0岁(范围,17~52岁);车祸伤2例,高处坠落伤2例,碾压伤1例。全部病例采用分期手术治疗,一期骨水泥填塞跟骨缺损皮瓣覆盖创面。清创后软组织缺损:2例10 cm×8 cm,8 cm×7 cm、8 cm×5 cm和5 cm×3 cm各1例。跟骨体部缺损:2例4 cm×3 cm×2 cm、2例3 cm×3 cm×2 cm和1例3 cm×1 cm×1 cm。二期通过3D打印联合Masquelet技术自体肋骨植骨重建跟骨缺损。术后定期随访观察植骨愈合情况、跟骨形态、内固定位置,采用Maryland评分和美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分评价足部功能。结果5例患者全部获得随访,随访时间18.2个月(范围,12~30个月)。一期手术后4例伤口愈合良好,1例于术后2个月发生深部感染,再次清创更换骨水泥后愈合。细菌培养:耐甲氧西林金黄色葡萄球菌3例、表皮葡萄球菌和大肠杆菌各1例。二期采用Masquelet技术自体肋骨植骨和3D打印个体性化钛网植入重建跟骨形状和结构。临床愈合时间4.32个月(范围,3~8个月);影像学检查跟骨植骨区域连续性骨小梁形成时间为13个月(范围,10~22个月)。术后12个月,Maryland评分为92分(范围,86~98分),其中优2例、良3例;AOFAS评分89.8分(范围,83~100分),其中优2例、良3例。1例一期术后发生深部感染,再次清创后治愈。结论3D打印个体化钛笼、Masquelet技术自体肋骨植骨重建跟骨是治疗跟骨感染性骨缺损的一种方法,术后疗效满意。
Objective To evaluate the clinical outcome of 3D printing titanium cage combined with Masquelet technology for the treatment of calcaneus infective defect.Methods Data of 5 cases with chronic calcaneus infectivedefect treated with regional flap,3D printing titanium cage combined with Masquelet technology with rib autograft from January 2017 to January 2019 were retrospectively analyzed.There were 3 males and 2 females,with an average age of 37 years old(range,17-52 years).The mechanism of the five patients included two motor vehicle incidents,two high fall injuries and one rolling compaction.All patients were treated by two-stage procedures.First stage included debridement,polymethyl methacrylate(PMMA)filling and regional flap coverage.The soft tissue defect of the 5 cases included 10 cm×8 cm in 2 cases,8 cm×7 cm,8 cm×5 cm,and 5 cm×3 cm each in one case.Bone defect included 4 cm×3 cm×2 cm in two cases,3 cm×3 cm×2 cm in two cases and 3 cm×1 cm×1 cm in one case.Second stage was 3D printing titanium cage combined with masquelet technology of rib autograft.Time of bone union,morphology of calcaneus,position of implant,Maryland score and AOFAS hind foot score were recorded to evaluate the clinical outcome.Results All five patients were followed up for an average time of 18.2 months(range,12-30 months).Infection happened in one patient 2 months after first stage operation and successfully treated by debridement and PMMA replacement.Incision of the rest 4 cases all healed successfully.Germiculture of the five cases included Methicillin-resistant Staphylococcus aureus(MRSA)in three cases,Staphylococcus epidermidis in one case and Bacterium coli in one case.All five patients got calcaneus bone union after second stage operation.The average time for bone union was 4.32(range,3-8)month.Bone trabecular were observed in CT scan 13(range,10-22)month post-operation.Average Maryland score in 12 months post-operation was 92(range,86-98)and average AOFAS ankle hind foot score was 89.8(range,83-100).Conclusion 3D printing
作者
赵建文
龙承
王晓伟
吴卓
宋占林
张建政
刘智
Zhao Jianwen;Long Cheng;Wang Xiaowei;Wu Zhuo;Song Zhanlin;Zhang Jianzheng;Liu Zhi(Department of Orthopaedics,the 7th Medical Center of PLA General Hospital,Beijing 100700,China;Department of Traumatic Orthopaedics,Anhua Country Shengli Orthopaedic Hospital,Anhua 413500,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2020年第5期310-316,共7页
Chinese Journal of Orthopaedics
关键词
跟骨
感染
创伤和损伤
Calcaneus
Infection
Wounds and injuries
