急诊Masquelet技术治疗前臂开放性骨折伴骨缺损的临床研究
Clinical study on acute Masquelet technique for the treatment of open forearm fractures with bone defects
周明 1贾雪原 1王鹏 1吴永伟 1王建兵 1马运宏 1刘军 1王亚朋 1康永强 1芮永军1
作者信息
- 1. 无锡市第九人民医院创伤骨科,无锡 214062
- 折叠
摘要
目的 探讨应用急诊Masquelet技术治疗前臂开放性骨折伴骨缺损的临床疗效.方法 回顾性分析自2018年9月至2021年3月,我们采用急诊Masquelet技术治疗16例前臂开放性骨折伴骨缺损患者,开放骨折按Gustilo-Anderson分型:ⅢA型1例,ⅢB型12例,ⅢC型3例.所有患者急诊一期行骨缺损处填充骨水泥,创面覆盖愈合后二期取出骨水泥,自体骨植骨.骨缺损部位:桡骨3例,尺骨9例,桡骨合并尺骨4例.骨缺损按Tetsworth等分型:D1(C)型6例,D3(A)型4例,D3(B)型6例.骨缺损长度为2.4～7.0 cm,平均3.8 cm.急诊固定方式:外固定4例,内固定10例,有限内固定联合外固定2例(使用外固定者在二期覆盖创面时更换为内固定).创面覆盖方式:直接闭合2例,植皮7例,皮瓣7例(游离股前外侧皮瓣6例,转移皮瓣1例).术后定期随访观察骨愈合情况、内固定位置,采用DASH上肢功能调查表评估功能结果.结果 术后16例患者均获得随访,时间为12～25个月,平均16.9个月.二期植骨时间为6～28周,平均15.3周.3例患者创面覆盖前存在表浅感染,经过彻底清创,创面覆盖后治愈.所有患者均在7 d内闭合创面,愈合良好,无皮瓣坏死及其他软组织并发症.所有患者植骨部位均愈合,临床骨愈合时间为9～20周,平均12.5周,无延迟愈合及骨不连发生.1例尺桡骨均伴有骨缺损的患者尺桡骨之间骨桥形成.末次随访时DASH评分为4.2-38.3分,平均18.9分.结论 急诊Masquelet技术是前臂开放性骨折伴骨缺损急性阶段一种安全有效的治疗方式,术后疗效满意.
Abstract
Objective To investigate the clinical efficacy of acute Masquelet technique for the treatment of open forearm fractures with bone defects.Methods A retrospective analysis was conducted from September 2018 to March 2021.We used acute Masquelet technique to treat 16 patients with open forearm fractures and bone defects.According to Gustilo-Anderson classification,open fractures were classified as typeⅢA in 1 case,type Ⅲ B in 12 cases,and type ⅢC in 3 cases.All patients underwent emergency first stage bone defect filling with bone cement,and after the wound was covered and healed,the bone cement was removed in the second stage,followed by autologous bone grafting.Location of bone defects:3 cases of radius,9 cases of ulna,and 4 cases of radius combined with ulna.According to Tetsworth's classification,bone defects were classified into D1(C)type in 6 cases,D3(A)type in 4 cases,and D3(B)type in 6 cases.The length of the bone defectswas 2.4 to 7.0 cm,with an average of 3.8 cm.Emergency fixation methods:external fixation in 4 cases,internal fixation in 10 cases,limited internal fixation combined with external fixation in 2 cases(those who use external fixation will be replaced with internal fixation when covering the wound in the second stage).Wound coverage methods:2 cases were directly closed,7 cases were skin grafts,and 7 cases were skin flaps(6 cases were free anterolateral femoral skin flaps,and 1 case was transferred skin flap).The regular postoperative follow-up observation of bone healing and internal fixation position was conducted,and DASH upper limb function questionnaire was used to evaluate functional results.Results All 16 postoperative patients were follow-up for a period of 12 to 25 months,with an average of 16.9 months.The interval form emergent operation to second phase of bone grafting was 6 to 28 weeks,with an average of 15.3 weeks.Three patients had superficial infection before wound coverage,and after thorough debridement,the wound was cured after coverage.All patients closed their wounds within 7 days,with good healing and no skin flap necrosis or other soft tissue complications.All patient bone grafting sites healed,with a clinical bone healing time of 9 to 20 weeks,an average of 12.5 weeks,and no delayed healing or bone nonunion occurred.The bone bridge was formed between the radius and ulna in a patient with bone defects in both the radius and ulna.At the last follow-up,the DASH score was 4.2 to 38.3 points,with an average of 18.9 points.Conclusion The acute Masquelet technique is a safe and effective treatment for open forearm fractures with bone defects in the acute stage,and the postoperative efficacy is satisfactory.
关键词
前臂/治疗结果/开放性骨折/骨缺损/Masquelet技术Key words
Forearm/Treatment outcome/Open fracture/Bone defects/Masquelet technique引用本文复制引用
基金项目
无锡市"太湖人才计划"顶尖医学团队课题(TTPJY2021)
出版年
2024
NETL
NSTL
万方数据