Masquelet技术在感染性指(掌)骨大段骨缺损治疗中应用.doc

Masquelet技术在感染性指(掌)骨大段骨缺损治疗中应用 　　【摘要】 目的：探讨Masquelet技术在修复感染性指（掌）骨大段骨缺损中的临床应用及疗效。方法：自2008年1月-2013年1月，感染性指（掌）骨大段骨缺损患者应用Masquelet技术，结合或不结合皮瓣修复指（掌）骨大段骨缺损21例。21例患者均为一期清创或内固定手术后感染，其中金黄色葡萄球菌感染者13例，链球菌7例，铜绿假单胞菌感染者1例。应用Masquelet技术，一期手术彻底清创后抗生素骨水泥占位填充骨缺损，6～8周后二期手术取出骨水泥，置入自体松质骨，修复骨缺损长度为11～33 mm，平均19 mm。结果：21例中手术成功20例，1例失败，原因为拇指近节指骨一期手术术后再次感染，后行再次清创、拇指短缩、关节融合术。手术成功者18例获得随访，失访2例。随访时间平均7个月。18例感染性指（掌）骨缺损患者中食指侧方皮瓣覆盖者3例，术后创面一期愈合18例，愈合时间10～15 d，二期手术后骨愈合时间2.6～3.5个月，平均愈合时间2.8个月，患指功能恢复满意。结论：Masquelet技术在修复感染性指（掌）骨大段骨缺损中效果良好。 【关键词】 Masquelet技术； 感染； 骨缺损； 骨修复 中图分类号 R658 文献标识码 A 文章编号 1674-6805（2013）33-0001-04 The Clinical Application of Masquelet Technique in the Treatment of Large Segmental Infective Phalanges or Metacarpal Defects/ZHAO Li-ning，TIAN Qing-ye，WANG Jian-guo.//Chinese and Foreign Medical Research，2013，11（33）：1-4 【Abstract】 Objective：To study effect of large segmental bone defects of phalanges（metacarpal） with Masquelet technique.Method：From January 2008 to January 2013，21 cases were therapied by Masquelet technique，with skin flap or not.All cases were infected after a debridement or internal fixation，including 13 cases of Staphylococcus aureus infection，7 cases of streptococcal infection，and 1 case of Pseudomonas aeruginosa infection.Masquelet technique involved a two-step procedure.First，bone cement was used to fill the bone defect after a thorough debridement；then the bone cement was removed after 6-8 weeks，and rich cancellous bone was implanted into the bone defect.Repairing the length of bone defect was vary from 11 mm to 33 mm（average 19 mm）.Result：20 cases were cured with the clinical application of Masquelet technique，1 case was failed，due to an re-infection after the first surgery，then underwent debridement，thumb shortening and arthrodesis.18 cases were followed up，2 cases were lost.The average follow-up times were 7 months.In the 18 cases，3 cases of bone defect fingers were repaired with side flap，18 cases of wound skin were healing in 10 to 15 days，bone he