From the Department of Orthopaedic Surgery (Dr. Ramos and Dr. Johnson), Loma Linda University, Loma Linda, CA, and the Department of Orthopaedic Surgery (Dr. Mariorenzi and Dr. Hayda), Warren Alpert Medical School of Brown University, Providence, RI.
J Am Acad Orthop Surg Glob Res Rev. 2020 Jul;4(7):e1900179. doi: 10.5435/JAAOSGlobal-D-19-00179.
Reconstruction of segmental diaphyseal bone defects has been a major challenge in limb salvage surgery. Staged reconstruction as first described by Masquelet is a common strategy to deal with this problem in limb salvage surgery. One consequence of this technique is a time period of prolonged limited weightbearing while the segmental defect heals. The purpose of this study was to describe an adjunctive technique for stage II of the Masquelet procedure and retrospectively analyze the outcome and weight bearing progression of 3 patients who sustained femur fractures with significant bone loss and underwent this technique. A retrospective chart review was performed. The patients (2 males, 1 female with an average age of 36.6 years) all sustained segmental femur fractures which resulted in significant bone loss. Induced membrane technique with adjunct use of a fibular strut allograft was performed after initial stabilization and PMMA spacer placement. All three patients went on to union and full weight bearing after being treated by the described technique. All the patients were allowed toe-touch weight bearing immediately after surgery and all progressed to weight bearing as tolerated at an average of 3.6 months. Using a fibular strut allograft as an adjunct to the induced membrane technique serves as a biologic and mechanical scaffold and may allow earlier weightbearing.
节段性骨干骨缺损的重建一直是保肢手术的主要挑战。Masquelet 首次描述的分期重建是保肢手术中处理这个问题的常用策略。该技术的一个后果是,在节段性缺损愈合期间,需要长时间限制负重。本研究旨在描述 Masquelet 二期手术的辅助技术,并回顾性分析 3 例股骨骨折伴严重骨丢失患者的结果和负重进展情况,这些患者接受了该技术治疗。进行了回顾性图表审查。3 名患者(2 名男性,1 名女性,平均年龄 36.6 岁)均发生节段性股骨骨折,导致严重的骨丢失。在初次稳定和 PMMA 间隔物放置后,采用诱导膜技术联合使用腓骨支柱同种异体骨。所有 3 名患者均采用描述的技术进行治疗后达到愈合并完全负重。所有患者术后立即允许足尖负重,所有患者平均在 3.6 个月时进展至耐受负重。将腓骨支柱同种异体骨作为诱导膜技术的辅助物,可作为生物和机械支架,并可能允许更早负重。
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