The Clinical Research Of The Masquelet Technique In Treating Infected Nonunion Of Lower Limb

Background:In recent years,there is an increase in traffic accident,with gradually increasing incidence of open fracture cases and also resulted in accompany increasing incidence of chronic osteomyelitis.Chronic osteomyelitis is caused by one or more microbial infection of bone or bone marrow inflammation for a long time,leading the fracture end with persistent infection,left to persistent fracture,thus forming septic bone nonunion.Children acute osteomyelitis which was not cured can also result in chronic osteomyelitis.Especially pathological fractures which had recurrence fracture also lead to the occurrence of septic bone nonunion.Septic bone nonunion characterized by infection and bone nonunion which are often accompanied by soft tissue defects,multiple sinuses,osteomyelitis,bone exposed,adjacent stiff joints,multiple drug-resistant bacteria infection,the limb length differ,complex deformity,etc.These types of infection leads the attending doctor to perform the amputation to prevent the further complications which include septic nonunion and the reoccurrence of the infection developed due to long history of infection.Amputation not only brings great pain for patients' body and mind,but also to the attending orthopedic surgeonto explain and do to counseling for the treatment procedure which is devastating problem for both of them.The basic concept for the development and treatment for the septic bone nonunion has unified principle,the main therapeutic principles is to eradicate the infection,as it become aseptic infected bone nonunion and is as treated for bone nonunion.Although the treatment principle of infected bone nonunion was unified,but there were different treatment methods,including four basic main methods:(1)Debridement and bone graft,(2)Free tissue transfer(bone,soft tissue or both),(3)Rich in antibiotic bone cement implantation,(4)Ilizarov technique.The Masquelet technology for treatment of septic bone nonunion is confirmed as a potential new treatment which includes,first stage include the premise of complete debridement by aggressive extraction of a lot of bone area,and later filling with bone cement to induced membrane,thus provided the suitable space for the formation of bone and consolidate,and can stimulate the formation of induced membrane;second stage implant cancellous bone into induced membrane.Purpose:To explore the clinical effect of the treatment of septic bone nonunion of lower limb by the Masquelet technique.Materials and methods:This study include 18 cases operation performed from September2014 to December 2016 after thorough the Masquelet technique for the treatment of infected bone nonunion of lower limb.Cases include: 11 cases of men and 7 cases of women;the average age of 42 years old;of these cases one was haematogenous osteomyelitis,17 cases were traumatic osteomyelitis.The involved infection bones: 1 case involved fibula;7 cases involved femur,10 tibial cases.Infection duration:infection time for at least 3 months,on average 10 months were included;the fracture zone in four patients with fistula formation,can be found in various degrees with pus or drainage.7 cases appeared the internal fixation device breakage,the limb is short and present with deformity.All the patients were treated by using Masquelet technique of two stages,surgery: first stage include a thorough debridement,fixed limb with external fixation,bone cement impregnated by vancomycin was filled in after remodeling bone defect,and finally close the wound with tension free suture.In the second stage,revision debridement was thoroughly done by dissecting and separating the soft tissue layer by layer,carefully revealed and dissects induced membrane;the bone cement impregnated was removed out,and then filled with bone graft into the induced membrane cavity then finally sutured layer by layer.During the stay of hospitalization post-operatively observation should be preferred for period of cure rate,recurrence rate of postoperative infection of bone,incision healing and healing time,presence of redness,fistula anddischarge.All the cases during hospitalization,laboratory indicators carefully observed till the normal reports were seen which include:routine blood examinations,ESR(erythrocyte sedimentation rate),CRP(C-reactive protein).The second stage was followed according to two aspects: imaging evaluation and functional evaluation.Results:A total of 18 patients with infected bone nonunion,all patients were followed up,the mean follow-up for all the patients 13.2 months(6-18months).A follow up period of eight to twelve weeks 16 patients with postoperative body temperature were normal;affected limb without inflammation appearance;wound was in healing process;ESR and CRP was in normal range;where two patient skin temperature was high at8-12 weeks after surgery,ESR and CRP was beyond the normal range,recurrence of bone infection was noted.The cases of recurrence of the bone infection was controlled by focal debridement again.The first debridement of postoperative inflammation control rate was 88.9%(16/18).Among 18 cases with Masquelet technology bone graft surgery had no recurrence of inflammation,there were 17 patients postoperatively healed within six months which was revised through radiography imaging,1 cases were delayed union.Thus bone healing rate within six months was 94.4%.The function of the lower limb is evaluated by according to Johner-Wruch evalution criterion for 18 patients,excellent involved 11 cases,good involved 4 cases,pass involved3 cases,the rate of excellent and good is 83.3%.Conclusion:1.Masquelet technology has beneficial in the treatment of lower limb septic nonunion and can acquire satisfied effects in bone results and functional outcomes.2.Masquelet technique in rebuilding infected bone defects,the length of the reconstruction reached above 10 centimeter,the bone healing rate in the graft area was higher.3.Fewer cases were reported,we will continue to improve the case data and carry out further research.