Masquelet technique and improved bone grafting for treatment of open tibial fractures of Gustilo-Anderson ⅢB with segmental bone defects
10.3760/cma.j.cn115530-20241223-00499
- VernacularTitle:膜诱导技术联合改良植骨技术治疗伴节段性骨缺损的Gustilo-Anderson ⅢB型胫骨开放性骨折的疗效分析
- Author:
Baobao XUE
1
;
Huanbo WANG
1
;
Chao YANG
1
;
Donglin LI
1
;
Junjun FAN
1
;
Bo GAO
1
Author Information
1. 空军军医大学西京医院骨科，西安 710032
- Publication Type:Journal Article
- Keywords:
Tibial fractures;
Fractures, open;
Bone transplantation;
Platelet-rich plasma;
Bone morphogenetic proteins;
Masquelet technique
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(3):189-196
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical effectiveness of Masquelet technique combined with improved bone grafting in the treatment of open tibial fractures of Gustilo-Anderson ⅢB with segmental bone defects.Methods:A retrospective study was conducted to analyze the clinical data of 13 patients with open tibial fracture of Gustilo-Anderson ⅢB with segmental bone defects who had been admitted to Department of Orthopeadics, Xijing Hospital, Air Force Medical University from January 2021 to May 2023. There were 9 males and 4 females with an age of (36.9±9.3) years. The length of tibial defects after debridement was (8.1±2.8) cm, and the area of soft-tissue defects 95.0 (53.6, 202.0) cm 2. At the first stage, Masquelet technique was used, soft-tissue defects were covered simultaneously or step by step, skin grafting was conducted on the donor site surface simultaneously, and survival of the tissue and skin grafts was observed. At the second stage, intramedullary space occupation with bone cement rods was conducted using improved bone grafting for which iliac bone, artificial bone, platelet rich plasma (PRP), and recombinant human bone morphogenetic protein-2 (rhBMP-2) were mixed; internal fixation was replaced. The interval between 2 stages of surgery was 4 to 7 weeks. The occurrence of infection, bone defect healing time, knee Lysholm score, ankle Mazur score, and knee and ankle ranges of motion at the last follow-up were recorded. The knee and ankle function scores before the second stage bone grafting and at the last follow-up were compared. Results:After the first-stage surgery, all the 13 patients did not need any revision with fine wound healing. After the second-stage surgery, all patients were followed up for (14.9±4.4) months with no infection at all. The healing time for bone defects was 8.0 (6.0, 12.0) months. At the last follow-up, the knee Lysholm score and the ankle Mazur score were (77.2±5.2) points and (76.1±10.9) points respectively, significantly different from those before the second-stage bone grafting [(41.3±7.5) points and (37.4±5.2) points] ( P<0.05). In the 13 patients at the last follow-up, ankle dorsiflexion limitation was 5.0° (0, 10.0°), knee flexion 105.0°±9.6°, and knee extension limitation 5.0° (5.0°, 5.0°). Conclusion:In the treatment of open tibial fractures of Gustilo-Anderson ⅢB with segmental bone defects, Masquelet technique combined with improved bone grafting can effectively prevent infection, repair bone defects, and restore the function of lower extremities, leading to definite curative efficacy.
