摘要
目的探讨Masquelet技术联合组织瓣移植治疗胫骨骨折内固定术后中早期感染性骨软组织复合缺损的临床疗效。方法2017年10月-2020年11月,中国人民解放军联勤保障部队第九八八医院骨科对12例13侧胫骨骨折内固定术后中、早期感染性骨软组织缺损患者,采取保留内固定的两阶段治疗。Ⅰ期彻底清除感染病灶,拆除失效螺钉,尽可能保留内植物,将可吸收硫酸钙抗生素链珠植入骨折远、近端髓腔,载抗生素骨水泥填充骨缺损并包裹内植物,同期采用组织瓣覆盖创面,创面缺损面积3.5 cm×5.0 cm~7.5 cm×14.5 cm,组织瓣切取面积为4.0 cm×5.5 cm~8.0 cm×15.0 cm。供区8侧直接拉拢缝合,5侧因无法完全闭合,拉拢缝合之后剩余创面行植皮覆盖。在感染指标和临床体征控制良好的前提下,于Ⅰ期术后6~9周Ⅱ期取出骨水泥,在利用Masquelet技术形成的诱导膜周围充分植入自体松质骨粒或复合同种异体骨,对于骨折不稳定者植入辅助钢板。出院后定期来院门诊复诊,之后采用门诊或微信方式随访,观察皮瓣的质地、颜色和骨愈合情况,末次随访时患肢功能参照Johner-Wruhs评定标准进行评定。结果Ⅰ期术后12例13侧皮瓣均顺利成活,无血管危象发生,伤口Ⅰ期愈合,仅2例2侧感染复发,经再次清创、取出内固定改换为外固定。Ⅱ期术后所有患者均获得12~26个月随访,平均18个月,13侧肢体骨折愈合良好,骨缺损愈合时间16~25(平均19.5)周,患肢功能参照Johner-Wruhs评定标准,优6侧、良5侧、中2侧。结论采用Masquelet技术联合组织瓣移植技术,将可吸收硫酸钙抗生素缓释剂链珠作为载体,在保留内植物的前提下,分阶段治疗胫骨内固定术后中、早期感染性骨缺损、骨外露具有可行性和较高的优良率,初步探索出程序化治疗创伤性骨感染复合缺损的方案。
Objective To explore the clinical efficacy of Masquelet technique combined with tissue flap transfer in the treatment of infectious composite bone and soft tissue defects in the early and middle stages after internal fixation for tibial fractures.Methods From October 2017 to November 2020,12 patients(13 tibial fractures)with infectious bone and soft tissue defects in the early and middle stages after internal fixation were treated in the Department of Orthopaedics,988th Hospital of the Joint Logistics Support Force of CPLA by two-phased surgery with retaining internal fixation.Phase I procedures were thoroughly removal of the infected lesions and failed screws,preserving internal implants as many as possible,implantation of absorbable calcium sulphate and an antibiotics blended string of beads into the distal and proximal medullary cavity of the fractured bones,filling the bone defect and wrapping the internal implants with antibiotics loaded bone cement.The size of defects was 3.5 cm×5.0 cm-7.5 cm×14.5 cm,and the flaps for wound coverage sized 4.0 cm×5.5 cm-8.0 cm×15.0 cm.As for the repair of donor site,8 limbs were sutured directly,5 limbs could not be closed completely,and the remaining wounds were covered by skin grafting after suture.Based on well control of infection and stable clinical signs,fillings of bone cement were then removed in Phase II surgery,or 6-9 weeks after primary surgery.Autologous cancellous bone pieces or composite allogeneic bone were fully implanted around the induction membrane formed by Masquelet technique,and auxiliary steel plates were implanted for internal fixation of unstable fractures.After discharge,the patients visited the outpatient clinic regularly,and combined with Wechat follow-up.The texture,colour and bone healing were observed.At the last follow-up,the function of the affected limbs were assessed according to Johner-Wruhs evaluation standard.Results After Phase I surgery,13 flaps survived smoothly without vascular compromise.The wounds healed in Phase I.Two patients
作者
胡智玉
李振峰
宋力
朱光显
幸超峰
陈鑫
陈旭
肖滋润
杨涛
熊颖杰
陈佳
仓飞成
张高伟
周明武
HU Zhiyu;LI Zhenfeng;SONG Li;ZHU Guangxian;XING Chaofeng;CHEN Xin;CHEN Xu;XIAO Zirun;YANG Tao;XIONG Yingjie;CHEN Jia;CANG Feicheng;ZHANG Gaowei;ZHOU Mingwu(Department of Orthopaedics,988th Hospital of the Joint Logistics Support Force of CPLA,Zhengzhou 450042,China;Department of Hand Surgery,Zhoukou Huaihai Hospital of Henan Province,Zhoukou,Henan Province 466000,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2023年第6期648-654,共7页
Chinese Journal of Microsurgery
基金
河南省医学科技计划项目(LHGJ20210810)。
