摘要
目的探讨Masquelet技术治疗开放性pilon骨折骨缺损的疗效。方法对2005年8月至2010年6月采用Masquelet技术治疗的16例开放性pilon骨折骨缺损患者的临床资料进行回顾性研究，男11例，女5例；年龄20～67岁，平均36．5岁；右侧10例，左侧6例；骨折按AO／ASIF分型：C2型7例，c3型9例。长段缺损5例，腔隙性缺损11例。开放性损伤按Gustilo分型：ⅢA型10例，ⅢB型6例。所有患者先进行清创，将带抗生素的骨水泥植入骨缺损处，并用外固定支架临时固定，6～8周后待软组织肿胀消退无明显感染迹象后拆除外固定支架，并行切开复位钢板内固定及植骨术。结果所有患者术后获6～48个月（平均24个月）随访，均未出现伤口深部感染和皮肤坏死。骨折复位影像学评估按照Burwell—Charnley标准：解剖复位6例，功能复位9例，复位差1例。骨折均获骨性愈合，愈合时间为13～58周，平均21周。踝关节功能按美国足踝外科协会的踝．后足功能评分标准评定，评分为62～98分，平均85．6分。结论采用Masquelet技术治疗开放性pilon骨折骨缺损可以取得良好的疗效，且手术方法简便。
Objective To evaluate the Masquelet technique used in the treatment of open pilon fractures complicated with segmental bone defects. Methods From August 2005 to June 2010, we used lhe Masquelet technique to treat 16 open pilon fractures with metaphyseal bone loss. They were 11 men and 5 women, aged from 20 to 67 years （average, 36.5 years）. Ten fractures were right and 6 left. By AO/ASIF classification, there were 7 cases of type C2 and 9 type C3. Five had long segmental defects and 11 lacunar defects. By Gustilo classification, 10 open injuries were type m A amt 6 type m B. All patients were treated with immediate debridement, antibiotic cement spacer placement at the site of the bone defect and external fixation. After a delay of 6 to 8 weeks when the patients had a healed soft tissue envelope and no sign of in- fection, they were treated with removal of external fixation, open reduction, bone grafting and plate fixation. Results All the patients were followed up from 6 to 48 months （average, 24 months）. Bone union was achieved in all patients, with an average duration of 21 weeks （from 13 to 58 weeks）. No acute deep infection or wound necrosis occurred after plate fixation. According to the Bm＇,＇ell-Charnley scoring, anatomic reduction was achieved in 6 cases, functional reduction in 9, and unsatisfactory reduction in one. According to the American Orthopaedic Foot and Ankle Society （AOFAS） scale for the ankle joint, the scores of ankle function ranged from 62 to 98 points, with an average of 85.6 points. Conclusion The Masquelet technique is simple but effective for the treatment of open pilon fractures complicated with bone defects.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2013年第9期742-746,共5页
Chinese Journal of Orthopaedic Trauma
