Fu Jingshu, Shen Jie, Wang Shulin, Sun Dong, Wang Xiaohua, Yu Shengpeng, Xie Zhao, Wu Hongri
Department of Orthopaedics, Banan Hospital of Chongqing Medical University, Chongqing, 401320, People's Republic of China.
Department of Orthopaedics, Southwest Hospital, Army Medical University, Gaotanyan No. 30, Chongqing, 400038, People's Republic of China.
Sci Rep. 2025 Jul 1;15(1):21107. doi: 10.1038/s41598-025-08386-4.
Structural and functional integrity pose a challenge for the treatment of fracture-related infections (FRI) in the shoulder girdle. The purpose of this study was to assess the clinical and functional outcomes of patients treated with the Masquelet technique. From January 2012 to January 2023, sixty-two consecutive adult patients with FRI in the shoulder girdle (8 in clavicle and 54 in humerus) were treated using this technique. This involved the use of antibiotic bone cement to fill the dead space after debridement, followed by staged bone grafting. Patients' outcomes, in terms of infection resolution, bone union, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score, were retrospectively analyzed. The follow-up time was at least 2 years. The mean age was 45.52±14.01 years. The initial fracture was open in 16 patients (25.8%) and closed in 46 patients (74.2%), Staphylococcus aureus (21.0%) was the most common pathogen. Thirty-six patients with large bone defects had additional locking plates for internal fixation. All patients achieved bone consolidation after a median follow-up of 24 months (range: 24-72 months) after the second stage bone graft. Clinical bone healing occurred at 4 months in 56.5%, at 6 months in 29.0%, and at 9 months in 14.5%. Seven patients required additional revision surgery. Three of these patients underwent repeated debridement before grafting due to incomplete infection control, while four had recurrence after the second-stage bone graft and required repeat surgery. The average DASH scores showed a significant decrease at the final follow-up, from a mean of 47.37 before surgery to a mean of 13.31. Following univariate analysis, patient age, post-debridement internal fixation, and bone graft type were not associated with the need for additional revision. However, patients aged ≥ 60 years (p = 0.004) and those with prolonged infection duration (p=0.002) were more likely to experience poor functional outcomes. The Masquelet technique, though requiring a staged approach, achieved reliable infection control and bony union in shoulder girdle FRIs, with favorable functional outcomes. This staged technique provided advantages through the use of antibiotic-loaded cement spacers, enabling local antibiotic treatment, dead space management, and post-debridement internal fixation.
结构和功能的完整性对肩胛带骨折相关感染（FRI）的治疗构成了挑战。本研究的目的是评估采用Masquelet技术治疗患者的临床和功能结果。2012年1月至2023年1月，连续62例成年肩胛带FRI患者（锁骨8例，肱骨54例）采用该技术治疗。这包括在清创后使用抗生素骨水泥填充死腔，随后进行分期植骨。回顾性分析患者在感染解决、骨愈合以及上肢、肩部和手部功能障碍（DASH）评分方面的结果。随访时间至少为2年。平均年龄为45.52±14.01岁。初始骨折16例（25.8%）为开放性，46例（74.2%）为闭合性，金黄色葡萄球菌（21.0%）是最常见的病原体。36例有大骨缺损的患者额外使用锁定钢板进行内固定。所有患者在第二阶段植骨后中位随访24个月（范围：24 - 72个月）后均实现了骨愈合。临床骨愈合在4个月时发生的占56.5%，6个月时占29.0%，9个月时占14.5%。7例患者需要额外的翻修手术。其中3例患者因感染控制不完全在植骨前进行了重复清创，而4例在第二阶段植骨后复发，需要再次手术。最终随访时平均DASH评分显著降低，从术前的平均47.37降至平均13.31。单因素分析后，患者年龄、清创后内固定和植骨类型与额外翻修的需求无关。然而，年龄≥60岁的患者（p = 0.004）和感染持续时间较长的患者（p = 0.002）更有可能出现功能结果不佳的情况。Masquelet技术虽然需要分期进行，但在肩胛带FRI中实现了可靠的感染控制和骨愈合，功能结果良好。这种分期技术通过使用含抗生素的骨水泥间隔物提供了优势，实现了局部抗生素治疗、死腔管理和清创后内固定。
