骨缺损、感染、坏死,咔咔一顿清创之后发现骨头不够用了,咋办?来来来,Masquelet 技术闪亮登场!本文整理了详细操作步骤,供大家参考。
概述
Masquelet 技术示意图
具体操作流程
可采用单臂或环形外固定支架固定,可以维持骨折端的稳定性,且能降低感染概率; 也可采用髓内钉固定,固定强度较高,可以早期进行锻炼,且有助于减少二期植骨量。
首先起到机械力学支撑的作用,防止纤维组织长入骨缺损区,为后期植骨的生长提供良好的生物微环境; 其次,PMMA 作为异物,刺激机体周围形成诱导膜,诱导膜起到生物保护作用,既可以促进植入骨的重建和再血管化,又避免了植入骨被吸收。
6 ~ 8 周后骨水泥周围诱导膜形成, 确认感染控制
若跳过引流,则有极大的可能发生血肿,继而导致植骨丢失。此阶段,骨的稳定性可通过髓内钉或钢板、外固定支架稳定固定患肢来实现。
骨缺损愈合及负重
二期手术不论采取何种固定方式,负重的过程都应该循序渐进,通常为植骨后的 6 ~ 7 个月。骨缺损愈合循序渐进,需要 1 ~ 2 年时间才能完全重建缺损的节段。
小结
Masquelet 技术可以有效治疗多个部位的创伤后骨缺损、感染性骨缺损、肿瘤切除后骨缺损、先天性胫骨假关节等。
作者:孙小六
图源:文末文献
参考文献
1.Kyle Kubes;Alex Friedman;Casey Pyle;Graal Diaz;Damayea Hargett; (2021). Management of twenty centimeter segmental bone defect of femoral shaft secondary to infected non-union of fracture using masquelet technique: A case report . International Journal of Surgery Case Reports, (), –. doi:10.1016/j.ijscr.2021.106107
2.John Mukhopadhaya , Janki Sharan Bhadani (2021).Masquelet technique for infected distal radius fractures with gaps in paediatric age group.Trauma Case Rep. 2021 Dec 8;37:100568.doi: 10.1016/j.tcr.2021.100568.
3.Andrea I. Alford;Daemeon Nicolaou;Mark Hake;Sarah McBride‐Gagyi; (2021). Masquelet's induced membrane technique: Review of current concepts and future directions . Journal of Orthopaedic Research, (), –. doi:10.1002/jor.24978
4.W R Daniel Seng , A X Rex Premchand(2021).Application of Masquelet technique across bone regions - A case series.Trauma Case Rep. 2021 Dec 24;37:100591. doi: 10.1016/j.tcr.2021.100591. eCollection 2022 Feb.
5.SCareri , R Vitiello, M S Oliva, A Ziranu, G Maccauro, C Perisano(2019).Masquelet technique and osteomyelitis: innovations and literature review.Eur Rev Med Pharmacol Sci. 2019 Apr;23(2 Suppl):210-216.doi: 10.26355/eurrev_201904_17495.
6.Raven, T.F.; Moghaddam, A.; Ermisch, C.; Westhauser, F.; Heller, R.; Bruckner, T.; Schmidmaier, G. (2019). Use of Masquelet technique in treatment of septic and atrophic nonunion. Injury, (), S0020138319303638–. doi:10.1016/j.injury.2019.06.018
7.Masquelet, Alain; Kanakaris, Nikolaos K.; Obert, Laurent; Stafford, Paul; Giannoudis, Peter V. (2019). Bone Repair Using the Masquelet Technique. The Journal of Bone and Joint Surgery, 101(11), 1024–1036. doi:10.2106/JBJS.18.00842
8. 骨折治疗的 AO 原则第三版
9. 金嘉诚.Masquelet 技术在骨缺损修复中的应用进展 [J]. 中医正骨,2019,31(6):32-34.
10.Walker, Matthew; Sharareh, Behnam; Mitchell, Scott A. (2018). Masquelet Reconstruction for Posttraumatic Segmental Bone Defects in the Forearm. The Journal of Hand Surgery, (), S0363502317319524–. doi:10.1016/j.jhsa.2018.07.003
11. 蔡成阔,舒衡生(2018). Masquelet 技术治疗骨缺损的研究进展. 中华骨科杂志, 2018,38(3) : 186-192.
12.Saxer, F.; Eckardt, H. (2017). Rekonstruktion ossärer Defekte mit der Masquelet-Technik; Reconstruction of osseous defects using the Masquelet technique; . Der Orthopäde, (), –. doi:10.1007/s00132-017-3443-1
13.Masquelet, Alain C. (2017). Induced Membrane Technique. Journal of Orthopaedic Trauma, 31(), S36–S38. doi:10.1097/BOT.0000000000000979
14.Giannoudis, Peter V.; Harwood, Paul J.; Tosounidis, Theodoros; Kanakaris, Nikolaos K. (2016). Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes. Injury, 47(), S53–S61. doi:10.1016/S0020-1383(16)30840-3
15.Morelli, Ilaria; Drago, Lorenzo; George, David A.; Gallazzi, Enrico; Scarponi, Sara; Romanò, Carlo L. (2016). Masquelet technique: myth or reality? A systematic review and meta-analysis. Injury, 47(), S68–S76. doi:10.1016/S0020-1383(16)30842-7
16.Mauffrey, C.; Barlow, B. T.; Smith, W. (2015). Management of Segmental Bone Defects. Journal of the American Academy of Orthopaedic Surgeons, 23(3), 143–153. doi:10.5435/jaaos-d-14-00018
17.Moghaddam, Arash; Zietzschmann, Severin; Bruckner, Thomas; Schmidmaier, Gerhard (2015). Treatment of atrophic tibia non-unions according to 『diamond concept』: Results of one- and two-step treatment. Injury, 46(), S39–S50. doi:10.1016/S0020-1383(15)30017-6
18.Masquelet, Alain C.; Begue, Thierry (2010). The Concept of Induced Membrane for Reconstruction of Long Bone Defects. Orthopedic Clinics of North America, 41(1), 27–37. doi:10.1016/j.ocl.2009.07.011
19.Paul R. Stafford; Brent L. Norris (2010). Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: a review of 25 cases. , 41(supp-S2), 0–0. doi:10.1016/s0020-1383(10)70014-0
20.Apard; N. Bigorre; P. Cronier; F. Duteille; P. Bizot; P. Massin (2010). Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing. , 96(5), 549–553. doi:10.1016/j.otsr.2010.02.010