Masquelet技术包括一个多孔无血管腓骨移植物重建大量创伤后骨缺损的军事实践。

IF 1.9 3区 医学 Q2 EMERGENCY MEDICINE
Laurent Mathieu, Ammar Ghabi, Thibault Druel, René Ayaovi Gayito Adagba, Antoine Grosset, Marjorie Durand, Jean-Marc Collombet, Christophe Andro
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引用次数: 0

摘要

背景:对于军事骨科医生来说,广泛骨缺损的处理是一个重大挑战,特别是在高强度冲突的背景下或当患者在现场得到充分治疗时。目的是评估诱导膜技术(IMT)包括多穿孔无血管腓骨移植物(NVFG)在军事创伤中心的理想条件和前方外科单位的严峻环境下重建大量骨缺损的效果。方法:对2019年1月至2023年6月期间在不同护理机构接受上述手术的患者进行回顾性病例研究。测量的结果包括骨愈合、骨愈合时间和愈合指数(骨愈合时间/重建骨长度)。功能评估基于Quick-DASH评分和下肢功能量表(LEFS)。结果:纳入9例患者,平均年龄37岁:5例在角色4医疗机构(MTF)管理,4例在角色2 MTF管理。5例患者在应用IMT前存在感染性骨缺损。清创后平均骨缺损长度为14 cm,平均骨缺损体积为190 cm3。两期之间的平均间隔为15周。平均随访时间为20个月。8/9例实现骨愈合,平均愈合时间8.1个月,平均愈合指数0.58个月/cm。只有持续性肱骨不连患者的dash评分较差。平均LEFS为68%。结论:在这个小队列中,IMT包括一个多孔NVFG,即使在前方手术单元的严峻环境下,只要事先控制了感染,也能成功重建股骨、胫骨和肱骨的大量骨缺损。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Masquelet technique including a multiperforated non-vascularized fibula graft for the reconstruction of massive post-traumatic bone defects in military practice.

Background: The management of extensive bone defects presents a significant challenge for military orthopedic surgeons, especially in the context of a high intensity conflict or when patients are fully treated in the field. The objective was to evaluate the induced membrane technique (IMT) including a multiperforated non-vascularized fibular graft (NVFG) for the reconstruction of massive bone defects performed in both the ideal conditions of military trauma centers and the austere environment of forward surgical units.

Methods: A retrospective case study was conducted on patients who underwent the above procedure in various care settings between January 2019 and June 2023. Outcomes measured included the achievement of bone union, time to bone union, and the healing index (time to bone healing/length of reconstructed bone). Functional assessment was based on the Quick-DASH score and the lower extremity functional scale (LEFS).

Results: Nine patients with a mean age of 37 years were included: five were managed in a role 4 medical treatment facility (MTF) and four in a role 2 MTF. Five patients had an infected bone defect before IMT application. After debridement, the mean bone defect length was 14 cm, and the mean bone defect volume was 190 cm3. The mean interval between stages was 15 weeks. The mean follow-up was 20 months. Bone union was achieved in 8/9 cases with a mean time of 8.1 months and a mean healing index of 0.58 month/cm. Only the patient with persistent humeral nonunion had a poor DASH-score. The mean LEFS was 68%.

Conclusions: In this small cohort, IMT including a multiperforated NVFG enabled successful reconstruction of massive bone defects in the femur, tibia, and humerus, even in the austere environment of forward surgical units, provided that prior infection control had been achieved.

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来源期刊
CiteScore
4.50
自引率
14.30%
发文量
311
审稿时长
3 months
期刊介绍: The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries. Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.
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