Masquelet 技术与一期骨移植治疗 感染性骨缺损的炎症控制效果比较

Comparison of inflammatory control effect between masquelet technique and one-stage bone grafting in treatment of infectious bone defects

摘要:

目的 对比分析Masquelet 技术与一期骨移植治疗感染性骨缺损的炎症控制效果及临床疗效。方法 回顾性分析2014 年1 月-2016 年8 月该院接受Masquelet 技术治疗的31 例下肢长骨创伤后骨髓炎骨缺损患 者（观察组）和2012 年1 月-2014 年7 月该院接受一期自体松质骨移植治疗的33 例同类患者（对照组）治 疗资料。比较两组炎症控制率、手术前后外周血C 反应蛋白（CRP）和降钙素原（PCT）变化情况、骨重建 长度和成功率、术后12 个月时骨缺损愈合效果及邻近关节功能恢复情况。结果 观察组术后炎症控制率与对 照组接近（90.32% vs 84.85%）（P >0.05），但观察组术后1 个月、3 个月PCT、CRP 水平低于对照组（P <0.05）； 观察组骨重建成功率高于对照组（96.77% vs 69.70%）（P <0.05），观察组中骨重建成功的骨不连患者，其骨重 建长度长于对照组（P <0.05）。观察组术后12 个月时骨缺损愈合效果及邻近关节功能恢复效果优于对照组 （P <0.05）；两组术后并发症发生率比较，差异无统计学意义（P >0.05）。结论 Masquelet 技术重建感染性骨 缺损对炎症因子的控制效果更好，且骨重建成功率更高、骨重建长度更长，患者中期关节活动功能更好。

Abstract:

Objective To compare inflammatory control effect and clinical efficacy between masquelet technique and one-stage bone grafting in treatment of infectious bone defects. Methods A retrospective analysis was made on 31 cases with osteomyelitis and bone defects after lower extremity trauma treated with Masquelet technique from January 2014 to August 2016 (the observation group), and 33 cases treated with autologous cancellous bone grafting from January 2012 to July 2014 (the control group). Inflammation control rate, peripheral C reactive protein (CRP) and procalcitonin (PCT) before and after treatment, bone reconstruction rate and reconstruction length, effect of bone defect healing and adjacent joint function after 12 months were observed and compared. Results The inflammation control rate in the observation group was close to that in the control group (90.32% vs. 84.85%) (P > 0.05), but PCT and CRP 1 and 3 months after treatment in the observation group were much less then those in the control group (P < 0.05). The bone reconstruction rate in the observation group was much higher than that in the control group (96.77% vs. 69.70%) (P < 0.05), patients with bone nonunion and being in reconstruction had longer reconstruction length in the observation group than that in the control group (P < 0.05). The effect of bone defect healing and the adjacent joint function 12 months after treatment in the observation group were better than those in the control group (P < 0.05). There was no significant difference in postoperative complication rate between the two groups (P > 0.05). Conclusion Compared with one-stage bone grafting, Masquelet technique has better inflammatory control effect, higher bone reconstruction rate, longer length of bone reconstruction and better midterm joint function in the treatment of infectious bone defect.