Ma Ching-Hou, Chiu Yen-Chun, Tsai Kun-Ling, Tu Yuan-Kun, Yen Cheng-Yo, Wu Chin-Hsien
Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Injury. 2017 Dec;48(12):2847-2852. doi: 10.1016/j.injury.2017.10.037. Epub 2017 Oct 26.
In the present retrospective study, we aimed to analyze the results of treatment for recalcitrant distal tibial nonunion using Masquelet technique with locking plate as a definitive external fixator.
We included 15 consecutive cases of distal tibial nonunion treated at our hospital between January 2012 and December 2015. The reconstructive procedure comprised debridement of the nonunion site, deformity correction, stabilization with an external locked plate, defect filling with cement spacer for inducing membrane formation, and bone reconstruction using a cancellous bone autograft (Masquelet technique). All patients were followed-up for at least one year.
Fracture union occurred in all cases after a median of 6.5 months (range, 5-12 months). Mean ankle motion ranged from 12.3 (range, 5-20) degrees of dorsiflexion to 35 (range, 5-55) degrees of plantar flexion. At the final follow-up, the median Iowa ankle score was 83 (range, 68-91). Eight patients had excellent scores, six had good scores, and one had fail score.
Although the current study involved only a small number of patients and the intervention comprised two stages, we consider that the used protocol is a simple and valuable alternative for the treatment of recalcitrant distal tibial nonunion.
在本回顾性研究中，我们旨在分析使用Masquelet技术结合锁定钢板作为确定性外固定器治疗顽固性胫骨远端骨不连的结果。
我们纳入了2012年1月至2015年12月在我院接受治疗的15例连续性胫骨远端骨不连病例。重建手术包括骨不连部位清创、畸形矫正、使用外固定锁定钢板固定、用骨水泥间隔物填充缺损以诱导膜形成以及使用松质骨自体骨进行骨重建（Masquelet技术）。所有患者均随访至少一年。
所有病例均在中位时间6.5个月（范围5 - 12个月）后实现骨折愈合。平均踝关节活动度范围为背屈12.3°（范围5 - 20°）至跖屈35°（范围5 - 55°）。在最后一次随访时，爱荷华踝关节评分中位数为83分（范围68 - 91分）。8例患者评分优秀，6例患者评分良好，1例患者评分失败。
尽管本研究仅涉及少数患者且干预为两阶段，但我们认为所采用的方案是治疗顽固性胫骨远端骨不连的一种简单且有价值的替代方法。
