| Objective To investigate the clinical eficacy of the Masquelet technique for reconstruction of large bone defects and continuous effect of the antibiotic cement intramedullary nail to anti-infection after debridement in adults with traumatic chronic osteomyelitis of tibial.Methods A totle of 28 adult patients with traumatic chronic osteomyelitis of tibial in our hospital from January 2011 to June 2015 were treated by the antibiotic cement intramedullary nail with the Masquelet technique.The mean interval from infection to operation was 7.2 months(ranged from 4 to 13 months),averaging(8.2±1.6)months.There are two phases in the whole course of treatment.We had used the antibiotic cement intramedullary nail to control the infection after debridment,and filled the antibiotic loaded cement spacers in the large bone defects to look forwords forming the artificial periosteum in the first phase.In the second phase,self-ilium graft had been used to large bone defects on the base of the artificial periosteum by the Masquelet technique.The follow-up evaluation included the number of operations,average day in hospital,the range of bone defect after debridement,whethere the infection was under control in the first phase.In the second phase,the Enneking Scoring Criterion?the Lane-Sandhu X-ray Score and the Chinese version of SF-36 scores were used in the assessment of limb function and quality of life pre-and post-operation.Results The average duration of follow-up was(26.8±5.2)months(ranged from 13 to 48 months).One patient had postoperative flap edge necrosis and one patient had superficialiliac incision infection,and no obvious complications were recorded.One patient recurred the infection.The infection of this patient was meticulously controlled after undergoing the treatment of careful debridement and changing the antibiotic cement intramedullary nail and the bone defect was well reconstructed by using the Masquelet technique.During the follow-up period,one patient showed up healing stimulin of the bone defects.We took out the sclerosis bone and kept gowning the artificial periosteum again.In the end,the bone defect was well reconstructed by using the Masquelet technique.26 patients obtained radiological union at a mean time of(5.5±0.8)months.All patients sufered from reinfection during follow-up,but 1 of them achieved complete bone healing after the second surgeries with the Masquelet technique.In the first phase,the average number of operations is(2~3)times,averaging(2.8±0.4)times.The mean day in hospital is(15.6±3.7)days.The length of bone defect was(4.2±10.5)cm after debridement,averageing(5.8±1.2),and perimeter of bone defect accounted for three-quarters of the perimeter of the coplanar tibia.The last debridement after 72 hours,the inflammatory indexes decreased obviously,and bacterial culture results were negative in operations.In the second?third?forth week after surgery,the inflammatory indexes in the normal range.At the last follow-up,the average Enneking score is(84.5±2.6)%.X-ray prompts that tibia healed well and no dead bone formation and the average Lane-Sandhu X-ray Score is(8.8±1.8).There was a substantial improvement in each dimension scores and total scores of SF-36 as compared with those before surgery(p < 0.05)(preoperative average grade was(56.4±13.1),and postoperative average grade was(78.3±6.8).The average grade of preoperation was significantly more than postoperattion).Conclusions Antibiotic cement intramedullary nail can control infection effectively in surgical debridment of adult chronic osteomyelitis of tibial.The Masquelet technique can effectively reconstruct large bone defects after debridement.The antibiotic cement intramedullary nail with the Masquelet technique can short treatment cycle,provide satisfactory results with minimal complications,promote good recovery of limbs function in treating adult chronic osteomyelitis of tibial.Two technologies are worth popularizing in clinical. |
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