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Masquelet-Ilizarov 技术治疗感染性胫骨骨不连清创后骨丢失。

Masquelet-Ilizarov technique for the management of bone loss post debridement of infected tibial nonunion.

机构信息

Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.

出版信息

Int Orthop. 2022 Sep;46(9):1937-1944. doi: 10.1007/s00264-022-05494-y. Epub 2022 Jun 30.


DOI:10.1007/s00264-022-05494-y
PMID:35773530
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9372116/
Abstract

PURPOSE: Masquelet and Ilizarov techniques have their advantages and shortcomings in the reconstruction of bone defects. The aim of this study was to evaluate the effectiveness of the combination of both techniques for the management of infected tibial nonunion to combine the advantages of both techniques with avoidance of shortcomings of both of them. PATIENTS AND METHODS: A prospective single-centre study was performed during the period from 2012 to 2019. Patients with the infected nonunion of the tibia with bone defect were included. Patients with pathological fractures or non-infected bone loss were excluded. Management protocol for all patients consisted of two stages. The first stage was Masquelet induced membrane technique and the second stage was Ilizarov bone transport. The results were assessed based on both objective (clinical and radiographic evaluation) and subjective criteria (limb function and patient satisfaction). RESULTS: Thirty-two patients were included in this study. The mean size of the defect was 6 cm. Ilizarov bone transport was done through the induced membrane chamber in all cases with an average follow-up of 28 months. Successful reconstruction without recurrence of infection was achieved in 30 cases (94%). No other bone or soft tissue procedure was needed with satisfactory functional outcome in 27 out of 30 cases (90%). Three cases had unsatisfactory results due to leg length discrepancy, joint stiffness, and persistent pain. CONCLUSIONS: Masquelet-Ilizarov technique can be used for the management of infected nonunion tibia with high satisfactory results without the need for complex soft tissue procedures.

摘要

目的:Masquelet 和 Ilizarov 技术在骨缺损重建中各有优缺点。本研究旨在评估两种技术联合应用于感染性胫骨骨不连的疗效,以结合两种技术的优点,避免两者的缺点。

方法:这是一项 2012 年至 2019 年期间进行的前瞻性单中心研究。纳入患有感染性胫骨骨不连伴骨缺损的患者。排除病理性骨折或无感染性骨丢失的患者。所有患者的治疗方案均分为两个阶段。第一阶段是 Masquelet 诱导膜技术,第二阶段是 Ilizarov 骨搬运。结果基于客观(临床和影像学评估)和主观标准(肢体功能和患者满意度)进行评估。

结果:本研究共纳入 32 例患者。缺损平均大小为 6cm。在所有病例中,均通过诱导膜室进行 Ilizarov 骨搬运,平均随访 28 个月。30 例(94%)成功重建,无感染复发。27 例(90%)患者功能结局满意,无需其他骨或软组织手术。3 例因肢体长度差异、关节僵硬和持续疼痛而结果不满意。

结论:Masquelet-Ilizarov 技术可用于治疗感染性胫骨骨不连,疗效满意,无需复杂的软组织手术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d70/9372116/75a4dd0ddf8b/264_2022_5494_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d70/9372116/9c5717d6d115/264_2022_5494_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d70/9372116/15d56963afab/264_2022_5494_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d70/9372116/13d09ed5f453/264_2022_5494_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d70/9372116/4a23a36a67cb/264_2022_5494_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d70/9372116/75a4dd0ddf8b/264_2022_5494_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d70/9372116/9c5717d6d115/264_2022_5494_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d70/9372116/15d56963afab/264_2022_5494_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d70/9372116/13d09ed5f453/264_2022_5494_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d70/9372116/4a23a36a67cb/264_2022_5494_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d70/9372116/75a4dd0ddf8b/264_2022_5494_Fig5_HTML.jpg

相似文献

[1]
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[2]
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[3]
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[7]
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[8]
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[2]
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[3]
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[4]
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[5]
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[6]
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J Orthop Case Rep. 2024-9

[7]
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Int Orthop. 2024-10

[8]
Applying 3D-printed prostheses to reconstruct critical-sized bone defects of tibial diaphysis (> 10 cm) caused by osteomyelitis and aseptic non-union.

J Orthop Surg Res. 2024-7-20

[9]
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[10]
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本文引用的文献

[1]
Ilizarov bone transport combined with the Masquelet technique for bone defects of various etiologies (preliminary results).

World J Orthop. 2022-3-18

[2]
Traumatic Composite Bone and Soft Tissue Loss of the Leg: Region-Specific Classification and Treatment Algorithm.

Injury. 2020-6

[3]
Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis.

Injury. 2017-7

[4]
Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes.

Injury. 2016-12

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Ilizarov bone transport combined with antibiotic cement spacer for infected tibial nonunion.

Int J Clin Exp Med. 2015-6-15

[6]
The treatment of infected tibial nonunion by bone transport using the Ilizarov external fixator and a systematic review of infected tibial nonunion treated by Ilizarov methods.

Acta Orthop Belg. 2014-9

[7]
Bone transport through an induced membrane in the management of tibial bone defects resulting from chronic osteomyelitis.

Strategies Trauma Limb Reconstr. 2015-4

[8]
Difficulties and challenges to diagnose and treat post-traumatic long bone osteomyelitis.

Eur J Orthop Surg Traumatol. 2015-1

[9]
Bone transport using the Ilizarov method: a review of complications in 100 consecutive cases.

Strategies Trauma Limb Reconstr. 2010-4

[10]
Acute shortening and re-lengthening in the management of bone and soft-tissue loss in complicated fractures of the tibia.

J Bone Joint Surg Br. 2007-1

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