感染性骨不愈合中的主要治疗方法比较
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摘要
目的探讨Masquelet技术与Ilizarov技术治疗感染性骨不愈合的疗效。方法本研究收集在山西医科大学第二医院创伤骨科使用Masquelet技术和使用Ilizarov技术治疗的感染性骨不愈合患者30例,男19例,女11例;年龄20～65岁,平均(32.6±11.22)岁。12例采用Masquelet技术,18例采用Ilizarov技术。统计治疗时间、治疗费用、手术数量、并发症及疗效评价,分析并比较两种技术的优劣。结果两组均获随访。Ilizarov技术组随访时间平均(18.04±3.67)个月,愈合时间平均(19.22±3.52)个月。Masquelet技术组随访时间平均(17.07±2.69)个月,愈合时间平均(6.00±2.17)个月。两组手术费用比较,差异有统计学意义(P<0.05);总手术次数比较,差异无统计学意义(P>0.05);控制感染手术次数及骨重建手术次数比较,差异有统计学意义(P<0.05)。结论目前的医疗水平及技术条件,两种术式均可以治疗感染性骨不愈合,但两种术式均有其明显的优缺点。Ilizarov技术可以不用顾忌骨缺损数量,可彻底控制感染;且该技术只需少量植骨或不需要植骨,对周围软组织环境要求较低。而Masquelet技术受制于骨缺损,不仅需要大量植骨,而且不能彻底清创,对损伤软组织需求较高,植皮常常为必要步骤;但其费用低、手术次数少,在治疗过程中更有利于患者。
Objective To explore the efficacy of Masquelet technology and Ilizarov technology in the treatment of infectious nonunion.Methods In this study 30 cases of infective nonunion treated by Ilizarov technique and Masquelet technique in the Department of Traumatic Orthopaedics of the 2 nd Hospital of Shanxi Medical University were collected.They were 20～65 years old with an mean age of(32.6±11.2)years old.12 cases were treated with Masquelet technique and 18 cases were treated with Ilizarov technique.The treatment time,cost,number of operations,complications and efficacy evaluation were studied.By analyzing the results,the advantages and disadvantages of the two technologies were compared.Results All patients in Ilizarov technique group were followed up for an average of(18.04 ±3.67)months.The average healing time was(19.22±3.52)months.The mean follow-up time of Masquelet technique group was(17.07±2.69)months,and the mean healing time was(6.00±2.17)months.There was significant difference in operation cost between the two groups(P<0.05);there was no significant difference in the total number of operations(P>0.05).There was significant difference in the number of infection control operations and the number of bone reconstruction operations(P<0.05).Conclusion With current medical level and technical conditions,the implementation of two kinds of surgical treatment of infectious nonunion can basically achieve the goal.Both methods have obvious advantages and disadvantages.Ilizarov technique can completely control infection without worrying about the number of bone defects and it has low or unnecessary requirement for bone grafting and low requirement for the surrounding soft tissue environment.Masquelet technique is limited by bone defect,which not only requires lots of bone grafts,but also can not be completely debrided.Skin grafting is often a necessary step.However,it has low cost and fewer operations,which is beneficial to patients in the course of treatment.
Objective To explore the efficacy of Masquelet technology and Ilizarov technology in the treatment of infectious nonunion.Methods In this study 30 cases of infective nonunion treated by Ilizarov technique and Masquelet technique in the Department of Traumatic Orthopaedics of the 2 nd Hospital of Shanxi Medical University were collected.They were 20～65 years old with an mean age of(32.6±11.2)years old.12 cases were treated with Masquelet technique and 18 cases were treated with Ilizarov technique.The treatment time,cost,number of operations,complications and efficacy evaluation were studied.By analyzing the results,the advantages and disadvantages of the two technologies were compared.Results All patients in Ilizarov technique group were followed up for an average of(18.04 ±3.67)months.The average healing time was(19.22±3.52)months.The mean follow-up time of Masquelet technique group was(17.07±2.69)months,and the mean healing time was(6.00±2.17)months.There was significant difference in operation cost between the two groups(P<0.05);there was no significant difference in the total number of operations(P>0.05).There was significant difference in the number of infection control operations and the number of bone reconstruction operations(P<0.05).Conclusion With current medical level and technical conditions,the implementation of two kinds of surgical treatment of infectious nonunion can basically achieve the goal.Both methods have obvious advantages and disadvantages.Ilizarov technique can completely control infection without worrying about the number of bone defects and it has low or unnecessary requirement for bone grafting and low requirement for the surrounding soft tissue environment.Masquelet technique is limited by bone defect,which not only requires lots of bone grafts,but also can not be completely debrided.Skin grafting is often a necessary step.However,it has low cost and fewer operations,which is beneficial to patients in the course of treatment.
引文
[1]Mcnally M,Ferguson J,Kugan R,et al.Ilizarov treatment protocols in the management of infected nonunion of the tibia[J].J Orthop Trauma,2017,31(Suppl 5):47-54.
[2]顾广新,乔晓峰,孙梦?.下肢骨骨折后骨不愈合的原因及治疗分析[J].中国全科医学,2007,10(20):1690-1691.
[3]Krappinger D,Lindtner RA,Zegg M,et al.Masquelet technique for the treatment of large dia-and metaphyseal bone defects[J].Oper Orthop Traumatol,2015,27(4):357-368.
[4]Rupp M,Biehl C,Budak M,et al.Diaphyseal long bone nonunions-types,aetiology,economics,and treatment recommendations[J].Int Orthop,2018,42(2):247-258.
[5]Akgun U,Canbek U,Aydogan NH.Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis[J].Injury,2018,49(3):738.
[6]王兴国,王兴义,王伟,等.llizarov技术治疗胫骨感染性骨不愈合失败后再次补救成功1例[J].中国骨伤,2013,26(9):787-788.
[7]曹建明,周亚净,朱巧辉,等.择期Ilizarov骨搬移技术治疗胫骨感染性骨缺损[J].实用骨科杂志,2016,22(11):980-984.
[8]Simpson AH,Tsang JST.Current treatment of infected non-union after intramedullary nailing[J].Injury,2017,48(Suppl 1):S82-S90
[9]Baruah RK,Haque R.Accordion maneuver with modified Ilizarov frame for treatment of recalcitrant nonunion of shaft of femur in a patient with pycnodysostosis[J].J Clin Orthop Trauma,2016,7(Suppl1):45-47.
[10]Cunningham BA,O’Connor DP,Brinker MR.High rate of union for aseptic distal tibial nonunions in adults treated with slow gradual compression via circular external fixation[J].J Orthop Trauma,2018,32.(6):301-305.
[11]Tong K,Zhong Z,Peng Y,et al.Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis[J].Injury,2017,48(7):1616-1622.
[12]Van Niekerk AH,Birkholtz FF,De Lange P,et al.Circular external fixation and cemented PMMAspacers for the treatment of complex tibial fractures and infected nonunions with segmental bone loss[J].J Orthop Surg(Hong Kong),2017,25(2):2309499017716242.
[13]Gouron R.Surgical technique and indications of the induced membrane procedure in children[J].Orthop Traumatol Surg Res,2016,102(Suppl 1):133-139.
[14]姚维华.胫骨不愈合及其治疗38例分析[J].现代中西医结合杂志,2007,16(12):1686.
[15]束伟平,王树金,吴树华.胫骨上段骨不愈合医源性原因分析及预防措施[J].医药前沿,2013,4(30):216-217.
[16]蒋亮东,陶澄,何爱咏,等.75例股骨骨折不愈合发生的原因分析[J].重庆医学,2014,2(8):970-972.
[17]Han W,Shen J,Wu H,et al.Induced membrane technique:Advances in the management of bone defects[J].Int J Surg,2017,6(42):110-116.
[18]Zhang Q,Zhang W,Zhang Z,et al.Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation[J].JOrthop Surg Res,2017,12(1):183.
[19]Willems A,van der Jagt OP,Meuffels DE.Extracorporeal shock wave treatment for delayed union and nonunion fractures:A systematic review[J].J Orthop Trauma,2019,33(2):97-103.
[20]Schlumberger M,Mayr R,Koidl C,et al.Treatment of tibial nonunion with bone defect using a heterotopic ossification as autologous bone graft:literature overview and case report[J].Eur J Orthop Surg Traumatol,2018,28(4):741-746.
[21]Giannoudis PV,Einhorn TA,Schmidmaier G,et al.The diamond concept-open questions[J].Injury,2008,39(2):5-8.
[22]Miska M,Findeisen S,Tanner M,et al.Treatment of nonunions in fractures of the humeral shaft according to the Diamond Concept[J].Bone Joint J,2016,98(1):81-87.
[23]黄进成,刘曦明,蔡贤华,等.Masquelet技术治疗感染性骨缺损的研究进展[J].中国矫形外科杂志,2017,25(20):1867-1871.
[2]顾广新,乔晓峰,孙梦?.下肢骨骨折后骨不愈合的原因及治疗分析[J].中国全科医学,2007,10(20):1690-1691.
[3]Krappinger D,Lindtner RA,Zegg M,et al.Masquelet technique for the treatment of large dia-and metaphyseal bone defects[J].Oper Orthop Traumatol,2015,27(4):357-368.
[4]Rupp M,Biehl C,Budak M,et al.Diaphyseal long bone nonunions-types,aetiology,economics,and treatment recommendations[J].Int Orthop,2018,42(2):247-258.
[5]Akgun U,Canbek U,Aydogan NH.Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis[J].Injury,2018,49(3):738.
[6]王兴国,王兴义,王伟,等.llizarov技术治疗胫骨感染性骨不愈合失败后再次补救成功1例[J].中国骨伤,2013,26(9):787-788.
[7]曹建明,周亚净,朱巧辉,等.择期Ilizarov骨搬移技术治疗胫骨感染性骨缺损[J].实用骨科杂志,2016,22(11):980-984.
[8]Simpson AH,Tsang JST.Current treatment of infected non-union after intramedullary nailing[J].Injury,2017,48(Suppl 1):S82-S90
[9]Baruah RK,Haque R.Accordion maneuver with modified Ilizarov frame for treatment of recalcitrant nonunion of shaft of femur in a patient with pycnodysostosis[J].J Clin Orthop Trauma,2016,7(Suppl1):45-47.
[10]Cunningham BA,O’Connor DP,Brinker MR.High rate of union for aseptic distal tibial nonunions in adults treated with slow gradual compression via circular external fixation[J].J Orthop Trauma,2018,32.(6):301-305.
[11]Tong K,Zhong Z,Peng Y,et al.Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis[J].Injury,2017,48(7):1616-1622.
[12]Van Niekerk AH,Birkholtz FF,De Lange P,et al.Circular external fixation and cemented PMMAspacers for the treatment of complex tibial fractures and infected nonunions with segmental bone loss[J].J Orthop Surg(Hong Kong),2017,25(2):2309499017716242.
[13]Gouron R.Surgical technique and indications of the induced membrane procedure in children[J].Orthop Traumatol Surg Res,2016,102(Suppl 1):133-139.
[14]姚维华.胫骨不愈合及其治疗38例分析[J].现代中西医结合杂志,2007,16(12):1686.
[15]束伟平,王树金,吴树华.胫骨上段骨不愈合医源性原因分析及预防措施[J].医药前沿,2013,4(30):216-217.
[16]蒋亮东,陶澄,何爱咏,等.75例股骨骨折不愈合发生的原因分析[J].重庆医学,2014,2(8):970-972.
[17]Han W,Shen J,Wu H,et al.Induced membrane technique:Advances in the management of bone defects[J].Int J Surg,2017,6(42):110-116.
[18]Zhang Q,Zhang W,Zhang Z,et al.Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation[J].JOrthop Surg Res,2017,12(1):183.
[19]Willems A,van der Jagt OP,Meuffels DE.Extracorporeal shock wave treatment for delayed union and nonunion fractures:A systematic review[J].J Orthop Trauma,2019,33(2):97-103.
[20]Schlumberger M,Mayr R,Koidl C,et al.Treatment of tibial nonunion with bone defect using a heterotopic ossification as autologous bone graft:literature overview and case report[J].Eur J Orthop Surg Traumatol,2018,28(4):741-746.
[21]Giannoudis PV,Einhorn TA,Schmidmaier G,et al.The diamond concept-open questions[J].Injury,2008,39(2):5-8.
[22]Miska M,Findeisen S,Tanner M,et al.Treatment of nonunions in fractures of the humeral shaft according to the Diamond Concept[J].Bone Joint J,2016,98(1):81-87.
[23]黄进成,刘曦明,蔡贤华,等.Masquelet技术治疗感染性骨缺损的研究进展[J].中国矫形外科杂志,2017,25(20):1867-1871.