【摘要】 背景:前臂骨髓炎合并骨缺损,特别是大段骨缺损,治疗难度大。诱导膜技术(Masquelet技术)修复下肢大段骨缺损取得满意疗效。目的:分析诱导膜技术修复前臂骨髓炎合并大段骨缺损的临床疗效。方法:回顾性分析2013年1月至2017年11月收治的12例前臂骨髓炎合并大段骨缺损患者。其中5例为桡骨骨缺损,7例为尺骨骨缺损。一期手术病灶区彻底清创后,采用抗生素骨水泥占位器填充缺损病灶诱导生物膜形成;二期手术取出骨水泥占位器后,植入自体松质骨或混合骨。随访记录患者术后骨缺损的愈合情况、并发症的发生情况,根据Anderson前臂功能评分标准,评估患肢的术后恢复情况。结果:所有患者均获得随访,随访时间为12～34个月,平均(17.5±3.3)个月。1例患者在一期术后出现感染复发,2例患者在二期植骨后期遗留肘关节僵硬,经治疗,感染控制、肘关节屈伸功能基本恢复。末次随访时,所有患者均实现骨与软组织愈合,根据Anderson前臂功能评分标准,本组病例优良率为83.3%(10/12)。结论:采用诱导膜技术修复前臂骨髓炎合并大段骨缺损疗优势明显,术后并发症少,骨缺损修复和患肢功能恢复效果满意。更多还原

【Abstract】 Background: It is very difficult to treat forearm osteomyelitis with bone defects, especially large bone defects. The induced membrane technique(Masquelet technique) has achieved satisfying clinical outcomes for large bone defects of lower limbs. Objective: To investigate the clinical efficacy of the induced membrane technique in repairing forearm osteomyelitis with large bone defects. Methods: Clinical data of 12 patients with forearm osteomyelitis and large bone defects admitted to our hospital from January 2013 to November 2017 were retrospectively analyzed. There were 5 cases of radial defects and 7 cases of ulnar defects. In the first stage, after thorough debridement, the biofilm was induced by filling the defect area with an antibiotic bone cement placeholder. In the second stage, after removal of the bone cement placeholder, autologous cancellous bone or mixed bone was implanted. Healing status and complications after surgery were recorded. The Anderson forearm function score was used to evaluate the recovery of the affected limb. Results: All the patients were followed up for a period of 12 to 34 months with an average of(17.5±3.3) months. One case had recurrence of infection after the first-stage operation, and 2 cases had elbow joint stiffness after bone grafting. The infection was controlled and the elbow function of flexion and extension were basically restored after treatment. At the last follow-up, all patients achieved bone and soft tissue healing. According to Anderson forearm function score, the excellent and good rate of this group was 83.3%(10/12). Conclusions: The induced membrane technique can achieve satisfactory bone defect repair and functional recovery of the affected limb with less postoperative complications in patients with forearm osteomyelitis and large bone defects.更多还原