Gupta Govind Kumar, Majhee Amit Kumar, Rani Sudha, Shekhar Shubhendu, Prasad Pancham, Chauhan Ganesh
Department of Orthopaedics, Sheikh Bhikhari Medical College, Hazaribagh, Jharkhand, India.
Department of Anatomy, Sheikh Bhikhari Medical College, Hazaribagh, Jharkhand, India.
J Family Med Prim Care. 2022 Jul;11(7):3660-3666. doi: 10.4103/jfmpc.jfmpc_2447_21. Epub 2022 Jul 22.
In earlier times due to difficulty in managing segmental long bone defects, amputation was the preferred treatment. Nonunion with bone loss of long bones is a challenging problem, requiring serious attention. Post-traumatic segmental bone defects can have severe long-term ill impact on patient's lives. Reconstruction is more difficult and functional outcome is usually less satisfactory compared to bony outcome. Distraction osteogenesis and induced membrane technique are the techniques that can be used.
To find out and compare clinical, radiological, and functional outcome of bone transport technique and induced membrane technique in management of bone defects in the long bones of lower limb.
A comparative study was conducted on 24 patients (22 males and 2 females) of lower extremity fractures with bone defect more than 3 cm. Patients were divided into two groups according to the method of reconstruction used, that is, either bone transport technique in 12 patients (group A) or masquelet in the other 12 patients (group B). The mean age of the patients was 44 years in group A and was 38 years in group B. Regular follow-up was done with a mean period of follow up of 18.35 ± 5.58 months in group A and 18.25 ± 3.95 months in group B.
In group A (bone transport), 67% showed union, 25% showed union with bone graft and 8% showed delayed union. In group B (masquelet), 75% showed union and 25% showed delayed union. bone transport technique showed excellent results in 58.3% and good in 41.7% while Masquelet technique showed excellent result in 50% and good in 50%.
For an orthopaedic surgeon, long bones defects with a substantial loss of bone volume are one of the most challenging bone defects encountered in clinical practice. Induced membrane technique and bone transport both offer successful options for filling of bone defects. Both techniques have its own pros and cons and provide varied option for healing. In our study, both methods have comparable results statistically although induced membrane technique required soft tissue reconstructive procedures.
在早期，由于节段性长骨缺损难以处理，截肢是首选的治疗方法。长骨骨不连伴骨丢失是一个具有挑战性的问题，需要引起高度重视。创伤后节段性骨缺损会对患者的生活产生严重的长期不良影响。与骨愈合结果相比，重建更加困难，功能结局通常也不太令人满意。牵张成骨术和诱导膜技术是可以采用的技术。
找出并比较骨搬运技术和诱导膜技术在治疗下肢长骨骨缺损中的临床、放射学和功能结局。
对24例下肢骨折且骨缺损超过3厘米的患者（22例男性，2例女性）进行了一项对比研究。根据所采用的重建方法将患者分为两组，即12例患者采用骨搬运技术（A组），另外12例患者采用Masquelet技术（B组）。A组患者的平均年龄为44岁，B组为38岁。进行了定期随访，A组的平均随访时间为18.35±5.58个月，B组为18.25±3.95个月。
在A组（骨搬运）中，67%实现了骨愈合，25%在植骨后实现了骨愈合，8%出现延迟愈合。在B组（Masquelet技术）中，75%实现了骨愈合，25%出现延迟愈合。骨搬运技术的优良率为58.3%，良好率为41.7%，而Masquelet技术的优良率为50%，良好率为50%。
对于骨科医生而言，骨量大量丢失的长骨缺损是临床实践中遇到的最具挑战性的骨缺损之一。诱导膜技术和骨搬运技术均为填充骨缺损提供了成功的选择。两种技术都有其优缺点，并为骨愈合提供了不同的选择。在我们的研究中，尽管诱导膜技术需要软组织重建手术，但两种方法在统计学上具有可比的结果。
