Moghaddam Arash, Zietzschmann Severin, Bruckner Thomas, Schmidmaier Gerhard
HTRG - Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury. Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany.
HTRG - Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury. Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany.
Injury. 2015 Oct;46 Suppl 4:S39-50. doi: 10.1016/S0020-1383(15)30017-6.
The successful treatment of atrophic tibia non-unions and tibia non-unions with large bone defects or infections is a major challenge in orthopedic and trauma surgery. This article evaluates the use of the 'diamond concept' using a one-step or two-step procedure according to 'Masquelet technique' in the treatment of atrophic tibia non-unions.
Between February 2010 and March 2014, 102 patients with atrophic non-unions were treated according to the 'diamond concept' in our center. Ninety-nine were available for follow-up. Forty-nine received a one-step treatment (Group 1, G1) and 50 patients received a two-step treatment according to the 'Masquelet technique' (Group 2, G2). Clinical and radiological parameters were measured preoperatively as well as 4, 6, and 12 weeks and 6 and 12 months postoperatively. In order to evaluate the subjective health of patients, we used the SF-12 questionnaire. Data analysis was performed one year after treatment.
The rate of consolidation in G1 was 84% and 80% in G2. The time to heal in G2 was 8.6 ± 2.9 months, which is significantly longer than in G1 being 6.9 ± 3.1 months. In comparison patients in G1/G2 had an average of 3.2/6.7 previous major surgeries. In G1, 4 of 8 patients who did not heal successfully showed positive intraoperative cultures. In G2, 26 patients (52%) initially presented with positive cultures. The results of the SF-12 questionnaire improved in both groups during the postoperative follow-up, but showed no significant differences between groups. In 29 patients a gentamycin-coated nail was used for reosteosynthesis. These patients showed by trend a lower rate of complications at a higher rate of consolidation.
Our study showed that the 'diamond concept' is a suitable method for safely and effectively treating non-unions with large defects or infections. The use of an antibiotic-coated nail provides a therapeutic benefit. For large bone defects of infected non-unions the two-step procedure after Masquelet is an efficient way to eradicate the infection and treat the bone defect successfully.
成功治疗萎缩性胫骨骨不连以及伴有大的骨缺损或感染的胫骨骨不连是骨科和创伤外科的一项重大挑战。本文评估了根据“Masquelet技术”采用一步法或两步法的“钻石概念”在治疗萎缩性胫骨骨不连中的应用。
2010年2月至2014年3月期间，在我们中心102例萎缩性骨不连患者根据“钻石概念”接受治疗。99例可供随访。49例接受一步治疗（第1组，G1），50例患者根据“Masquelet技术”接受两步治疗（第2组，G2）。术前以及术后4周、6周、12周、6个月和12个月测量临床和放射学参数。为了评估患者的主观健康状况，我们使用了SF-12问卷。治疗一年后进行数据分析。
G1组的骨愈合率为84%，G2组为80%。G2组的愈合时间为8.6±2.9个月，明显长于G1组的6.9±3.1个月。相比之下，G1/G2组患者之前平均分别接受过3.2/6.7次大手术。在G1组，8例未成功愈合的患者中有4例术中培养结果呈阳性。在G2组，26例患者（52%）最初培养结果呈阳性。SF-12问卷的结果在术后随访期间两组均有改善，但两组之间无显著差异。29例患者使用了庆大霉素涂层钉进行再骨合成。这些患者并发症发生率呈下降趋势，骨愈合率较高。
我们的研究表明，“钻石概念”是安全有效治疗伴有大的骨缺损或感染的骨不连的一种合适方法。使用抗生素涂层钉具有治疗益处。对于感染性骨不连的大骨缺损，Masquelet术后两步法是根除感染并成功治疗骨缺损的有效方法。
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