RESUMO
Objective To analyze the therapeutic effect of Masquelet technique in the treatment of bone defects.Methods From January 2008 to December 2014,20 patients with bone defects were treated by Masquelet technique.There were 15 males and 5 females,from 18 to 69 years of age (average,38.4 years).Four cases had open bone defects and 16 infectious ones.At the first stage,radical debridement of the bone defects and soft tissue was conducted via conventional approaches.The bone defects ranged from 2 to 9 cm,averaging 6.1 cm.At the second stage,internal fixation was applied in 18 cases and external fixation in 2.The interval from the second stage to the first stage operation ranged from 6 to 23 weeks (average,11.5 weeks).The healing of bone defects and the functional recovery of adjacent joint were evaluated by Paley scoring at the last follow-up.Results The 20 patients were followed up for 12 to 50 months (average,19.7 months) after the second stage operation.All the patients obtained uneventful wound healing and control of infection after the first stage operation except the one with infectious defects who had to receive 2 operations to control the infection at the first stage operation.At the second stage operation,obvious injury and defect of the induced membrane occurred in 4 cases.All the patients achieved clinical healing of bone defects after 3 to 6 months (average,4.8 months).The bone defect healing was graded as excellent in all.After bone healing,all the patients resumed weight-bearing activities,with no breakage or infection of fixators,or recurrence of infection.By the Paley scoring at the last follow-up,the functional recovery of the adjacent joint was excellent in 8 cases,good in 10 and fair in 2,yielding an excellent and good rate of 90.0％.Conclusion As a kind of modified free bone grafting,Masquelet technique has advantages of simplicity,limited complications,a high rate of healing,and good control of bone infection.
RESUMO
Objective To investigate the influencing factors and technical points of induced membrane technique for treatment of bone defect.Methods All of 20 patients of bone defect were treated by induced membrane technique in our hospital from January 2008 to November 2014,including 15 males and 5 females;aged 13-69,average 38.5;infectious bone defect in 16 cases and non-infectious bone defect in 4 cases.Record the complications,evaluate the healing of bone defect and functional recovery of adjacent joints by Paley method,respectively,and grade the range of movement (ROM) of adjacent joints by authors's method.Results In the first stage of surgery,1 case needed a second operation as the wound gradually spitted and bone cement contaminated after tighten closure of the skin flap,while others had no infection or recurrence of infection.In the second stage of surgery,3 cases had induced membrane damage and defect.All were followed-up from 12 to 50 months (average 19.7 months);all the bone defects healed,the clinical healing time was 3.0 to 7.0 months (average 4.7 months).The healing time in the 3 cases with induced membrane damage and defect (average 6.0 months) was longer than that in patients without induced membrane damage and defect(average 4.6 months).1 case of infectious bone defect with induced membrane damage and defect had local infection in 6 months after the second stage of surgery,for whom the conservative treatment was invalid but got controlled after second operation while 1 case of infectious bone defect without induced membrane damage and defect had local infection in 12 months after second stage of surgery,in whom the infection was controlled by the conservative treatment,the others had no infection or recurrence of infection,no broken of fixators noted;at the last follow-up,all the bone defect healing graded excellent,the functional recovery of the adjacent joints graded:excellent in 8 cases,good in 10 cases,and fair in 2 cases (the excellent and good rate was 90％),the ROM of the adjacent joints graded:excellent and good in 8 cases,respectively,fair and poor in 2 cases,respectively (the excellent and good rate was 80％).Conclusion Induced membrane technique has advantages of simple surgery,faster healing of bone defect,no correlation between the healing time and the length of bone defect,fewer complications,etc,but in clinical application,the operators must understand the therapy principle and pay attention to the influencing factors and technical points so as to avoid operation errors,reduce complications and improve therapeutic effect.