膜诱导技术治疗长骨骨缺损
Management of Large Bone Defects in Diaphyseal Fractures by Induced Membrane Formation by Masquelet’s Technique
DOI: 10.13107/jocr.2250-0685.508
Introduction: Management of the large gap in long bone fractures is a challenging problem after compound injuries. A novel technique called as Masquelet’s technique of “induced membrane膜 formation”, is used to bridge a gap填补空白 of more than 5 cm using bone cement骨水泥 as a spacer in first stage and autologous cancellous bone自体松质骨 graft to fill the gap in second stage.
Case presentation: We present two different and difficult cases with bone defects after open injuries associated with long bone fractures in this paper. First case is a 50-year-old lady with grade IIIa open fracture right distal femur with intra-articular extension and bone loss. She underwent wound debriment清创术, stabilization of the fracture with locking compression plate along with antibiotic cement spacer, which is removed latter and underwent bone grafting. Another is a 15-year-old boy with open grade IIIb fracture tibia and fibula (mid-distal third junction中下三分之一) of right leg, wound debridement and ankle spanning triangular external fixation跨踝关节三角形外固定 was applied on same day and after two months, external fixation was removed due to florid花斑？infection and plaster of Paris（熟）石膏 was applied. Instead of the tedious 单调的and demanding苛刻的 treatment options like Ilizarov, a new technique described by Masquelet is used here. It uses bone cement as a spacer to fill the cavity to form pseudo-membrane 假膜around it and in the second stage autologous cancellous bone graft fills the gap of even more than 5 cm, to achieve union.
Conclusion: The membrane also secretes分泌 vascular and osteo-inductive factors骨诱导因子 to stimulate bone regeneration and also prevents resorption of the bone骨吸收 graft and achieves early fracture healing avoiding tedious options like bone transport骨搬运 in external fixator. By this two staged technique, union occurred clinically and radiologically in these two cases.
百度翻译：
前言：长骨骨折复合伤后大间隙的处理是一个具有挑战性的问题。一种称为Masquelet“诱导膜形成”的新技术，在第一阶段用骨水泥作为间隔物，在第二阶段用自体松质骨移植填补超过5cm的间隙。
病例介绍：我们提出两个不同和困难的病例，开放性损伤后骨缺损合并长骨骨折。第一例为50岁女性，右股骨远端IIIa级开放性骨折，关节内延长，骨丢失。她接受了伤口清创，用锁定加压钢板和抗生素骨水泥间隔物固定骨折，后者被移除并进行骨移植。另一例为15岁男童，右腿胫腓骨（中下第三节）开放性IIIb级骨折，当日行创面清创及踝关节跨越三角外固定，术后2个月，因感染发花而取出外固定架，行石膏固定。这里使用了Masquelet描述的一种新技术，而不是像Ilizarov这样单调而苛刻的治疗方法。它以骨水泥为间隔物填充空腔，在空腔周围形成假膜，在第二阶段自体松质骨移植填充间隙甚至超过5cm，达到愈合。
结论：该膜还分泌血管和骨诱导因子，促进骨再生，防止骨移植的吸收，避免了骨在外固定支架中的运输等繁琐的选择，实现骨折早期愈合。通过这两个阶段的技术，这两个病例在临床和放射学上发生了结合。
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