改良Masquelet技术与胫骨近端干骺端一期短缩术治疗酒精性神经病变患者的胫骨近端感染性骨不连：病例报告
Modified Masquelet Technique and Primary Tibial Metaphyseal Shortening for the Management of Proximal Tibial-infected Non-union in a Patient with Alcohol-induced Neuropathy: A Case Study.
作者信息
Mahmoud Ahmed Nageeb, Watson John Tracy, Horwitz Daniel S
机构信息
Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania, United States of America; Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, Missouri, United States of America.
出版信息
Strategies Trauma Limb Reconstr. 2023 Sep-Dec;18(3):181-185. doi: 10.5005/jp-journals-10080-1604.
AIM
To highlight the role of the Masquelet technique as a limb salvage procedure for a neuropathic patient presenting with infected non-union of proximal tibia.
BACKGROUND
The management of an infected non-union in neuropathic patients is most challenging; with various treatment options available, the prognosis is often guarded.
CASE DESCRIPTION
A 37-year-old male with chronic polyneuropathy, also possessing a contralateral midfoot Charcot arthropathy secondary to a history of alcohol abuse, developed infection after a proximal tibial osteotomy for a preceding mal-non-union of a proximal tibia fracture. The management included hardware removal, excision of necrotic bone, interim insertion of antibiotic-loaded bone cement followed by an acute shortening and revision of the internal fixation utilising a second surgical incision. Successful bone union and eradication of infection was achieved and maintained after 13 months follow-up.
CONCLUSION
A successful outcome was achieved for an infected non-union of a long bone in a neuropathic patient using the Masquelet technique which was then followed with a second-stage removal of the spacer and shortening. By performing the revision ORIF surgery utilising a different skin incision in the setting of complicated previous surgical scars proved to be a viable technique towards reducing risk of recurrence of infection and a good outcome.
CLINICAL SIGNIFICANCE
Utilisation of the Masquelet technique and limb shortening in a staged manner for the management of long bone infections in neuropathic patients has not been reported before and may be valuable in such demanding clinical situations.
HOW TO CITE THIS ARTICLE
Mahmoud AN, Watson JT, Horwitz DS. Modified Masquelet Technique and Primary Tibial Metaphyseal Shortening for the Management of Proximal Tibial-infected Non-union in a Patient with Alcohol-induced Neuropathy: A Case Study. Strategies Trauma Limb Reconstr 2023;18(3):181-185.
目的
强调Masquelet技术作为一种肢体挽救手术，用于治疗患有胫骨近端感染性骨不连的神经性患者的作用。
背景
神经性患者感染性骨不连的治疗极具挑战性；尽管有多种治疗选择，但预后往往不佳。
病例描述
一名37岁男性，患有慢性多发性神经病，因酗酒史继发对侧中足夏科氏关节病，在因先前胫骨近端骨折畸形不愈合行胫骨近端截骨术后发生感染。治疗措施包括取出内固定物、切除坏死骨、临时植入含抗生素骨水泥，随后通过第二个手术切口进行急性缩短和内固定翻修。随访13个月后，实现并维持了骨愈合和感染清除。
结论
使用Masquelet技术成功治疗了神经性患者的长骨感染性骨不连，随后进行了二期间隔物取出和缩短手术。在先前手术瘢痕复杂的情况下，通过不同的皮肤切口进行翻修切开复位内固定手术被证明是一种可行的技术，可降低感染复发风险并取得良好效果。
临床意义
此前尚未报道过分期使用Masquelet技术和肢体缩短治疗神经性患者长骨感染，在这种高要求的临床情况下可能具有重要价值。
如何引用本文
Mahmoud AN, Watson JT, Horwitz DS. Modified Masquelet Technique and Primary Tibial Metaphyseal Shortening for the Management of Proximal Tibial-infected Non-union in a Patient with Alcohol-induced Neuropathy: A Case Study. Strategies Trauma Limb Reconstr 2023;18(3):181-185.
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