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Tibiadefekt- und Infektpseudarthrosen

Behandlungsergebnisse nach Masquelet-Technik

Tibial defects and infected non-unions

Treatment results after Masquelet technique

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Zusammenfassung

Fragestellung

Die Behandlung von Defekt- und Infektpseudarthrosen stellt eine Herausforderung in der Unfallchirurgie und Orthopädie dar. Ein neues Therapiekonzept ist die zweizeitige Behandlung nach der Masquelet-Technik.

Methodik

In der Zeit von Februar 2010 bis Juni 2014 wurden 55 Patienten mit einer Tibiadefekt- oder Infektpseudarthrose in unserem Haus im Sinne einer zweizeitigen Masquelet-Operation behandelt. Die Patienten waren im Durchschnitt 48 (Median 50; 15–72) Jahre alt, mit einem durchschnittlichen BMI (Body-Mass-Index) von 28 (27; 18–52). Das Geschlechterverhältnis lag bei weiblich : männlich 1 (18 %) zu 4,5 (82 %). Alle Patienten wurden im Rahmen der Studie nachuntersucht. Es wurden Daten zur Knochenheilung, der klinisch funktionellen Untersuchung sowie zu subjektiven Patientenangaben bezüglich Schmerzen und alltäglichen Beeinträchtigungen erhoben.

Ergebnisse

In 42 Fällen (76,4 %) kam es zu einer ausreichenden knöchernen Konsolidierung. Die durchschnittliche Heilungszeit betrug 10,3 (8,5; 3–40) Monate. Die durchschnittliche Defektstrecke betrug 4 cm (3 cm; 0,6–26 cm). Im Durchschnitt waren die Patienten 6‑mal (Median 4; range 1–31) voroperiert. In allen Fällen erfolgte eine Reosteosynthese und die Defektauffüllung mit durch RIA (Reamer-Irrigator-Aspirator) gewonnenem autologem Knochen und dem osteoinduktiven Wachstumsfaktor BMP-7 (bone morphogenetic protein-7). In 13 Fällen (23,6 %) konnte kein Therapieerfolg festgestellt werden. Die Auswertung des SF12-Fragebogens ergab eine Erhöhung des Scores zur psychischen Gesundheit von 47,4 (49,1; 27,6–65,7) auf 49,8 (53,0; 28,7–69,4), die Auswertung der körperlichen Gesundheit eine Erhöhung von 32,7 (32,7; 16,9–55,7) auf 36,6 (36,5; 24,6–55,9).

Schlussfolgerung

Die Ergebnisse zeigen, dass der Knochenaufbau in der zweizeitigen Masquelet-Technik eine Erfolg versprechende Therapieoption von Tibiapseudarthrosen ist. Gerade bei langstreckigen Defekten und Infektsituationen im Tibiaschaftbereich ist die Anwendung mit einer hohen Patientensicherheit möglich.

Abstract

Background

The treatment of non-unions with large bone defects or osteitis is a major challenge in orthopedic and trauma surgery. A new concept of therapy is a two-step procedure: Masquelet technique according to the diamond concept.

Methods

Between February 2010 and June 2014, 55 patients with tibia non-unions or infections were treated in a two-step Masquelet technique in our center. The patients’ average age was 48 (median 50; minimum 15–maximum 72) with an average BMI (body mass index) of 28 (27; 18–52). There were 10 (18 %) female and 45 (82 %) male patients in the group. All study patients went through a follow up. Bone healing and clinical functional data were collected, as well as data according to subjective patient statements about pain and everyday limitations.

Results

In 42 cases (76.4 %) the outcome was a sufficient bony consolidation. On average, the time to heal was 10.3 (8, 5; 3–40) months, defect gaps were 4 cm (3 cm; 0,6–26 cm), and on average the patients had had 6 (median 4; range 1–31) previous operations . In all cases patients received osteosynthesis as well as a defect filling with RIA (reamer-irrigator-aspirator), and growth factor BMP-7 (bone morphogenetic protein-7). In 13 cases (23.6 %) there was no therapeutic success. In the evaluation of the SF12 questionnaire the mental health score increased from 47.4 (49.1; 27.6–65.7) to 49.8 (53.0; 28.7–69.4) and the well-being score from 32.7 (32.7;16.9–55.7) to 36.6 (36.5; 24.6–55.9).

Conclusion

The two-step bone grafting method in the Masquelet technique used for tibia non-unions according to the diamond concept is a promising treatment option. Its application for tibia shaft non-unions with large bone defects or infections means a high degree of safety for the patient.

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Authors and Affiliations

  1. HTRG-Heidelberg Trauma Research Group, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland

    A. Moghaddam, C. Ermisch, C. Fischer, S. Zietzschmann & G. Schmidmaier

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  1. A. Moghaddam
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  2. C. Ermisch
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  3. C. Fischer
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  4. S. Zietzschmann
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  5. G. Schmidmaier
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Correspondence to A. Moghaddam.

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Interessenkonflikt

A. Moghaddam, C. Ermisch, C. Fischer, S. Zietzschmann und G. Schmidmaier geben an, dass kein Interessenkonflikt besteht.

Die Studie wurde mit Zustimmung der zuständigen Ethik-Kommission (S-532/2011, S-636/2011), im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen Patienten liegt eine Einverständniserklärung vor.

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Moghaddam, A., Ermisch, C., Fischer, C. et al. Tibiadefekt- und Infektpseudarthrosen. Orthopäde 46, 263–274 (2017). https://doi.org/10.1007/s00132-016-3305-2

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