Bieler Dan, Franke Axel, Willms Arnulf, Hentsch Sebastian, Kollig Erwin
Department for Trauma Surgery and Orthopedics, Reconstructive Surgery, Hand Surgery, Burn Medicine, German Armed Forces Central Hospital, Ruebenacher Strasse 170, 56072 Koblenz, Germany.
Mil Med. 2014 Sep;179(9):e1053-8. doi: 10.7205/MILMED-D-13-00530.
Treatment of osseous defects of the extremities is a constantly recurring challenge in modern reconstructive surgery. This applies, in particular, to military surgery, especially to the sequelae of gunshot and blast injuries. Severe soft-tissue damage and inevitable contamination lead to an increased rate of infection. Repetitive surgical debridement involving the bone must be performed at regular intervals. Frequent outcomes are osseous defects that call for a consistent therapeutic concept adapted to the individual patient. The Masquelet technique is an additional bone reconstruction method with which to sufficiently treat initially infected long bone defects in multiple operations. Following radical debridement, the resulting bone defect is completely filled with a bone cement spacer loaded with antibiotics. At the boundary layer between the spacer and soft tissue, a membrane expressing growth factors will develop over several weeks. This has a favorable effect on the successful transplantation and ossification of autologous cancellous graft following spacer removal. This technique will be illustrated by a case study. Since this technique has already proved successful in reconstructing defects of up to 25 cm, it is an alternative to various callus distraction methods as well as vascularized bone transfer.
肢体骨缺损的治疗是现代重建外科中经常遇到的挑战。这尤其适用于军事外科，特别是枪伤和爆炸伤的后遗症。严重的软组织损伤和不可避免的污染导致感染率增加。必须定期对骨骼进行反复的外科清创。常见的结果是骨缺损，这需要一种适合个体患者的连贯治疗理念。Masquelet技术是一种额外的骨重建方法，可在多次手术中充分治疗最初感染的长骨缺损。在彻底清创后，所产生的骨缺损用装载抗生素的骨水泥间隔物完全填充。在间隔物与软组织的边界层，一种表达生长因子的膜将在数周内形成。这对间隔物取出后自体松质骨移植的成功移植和骨化有有利影响。本技术将通过一个案例研究来说明。由于该技术已被证明在重建长达25厘米的缺损方面是成功的，它是各种骨痂牵张方法以及带血管骨转移的一种替代方法。
