Defectos óseos segmentarios infectados en huesos largos: tratamiento con técnica de Masquelet.[Masquelet technique for the treatment of infected segmental long-bone defects]

Germán Garabano, César Pesciallo, Alfredo Montero Vinces, Diego José Gómez, Fernando Bidolegui, Alberto Cid Casteulani

Resumen


Introducción: Los defectos óseos segmentarios infectados son entidades de complejo tratamiento. La técnica de Masquelet representa una alternativa para estos casos. El objetivo de este estudio retrospectivo, multicéntrico fue mostrar los resultados clínicos y radiológicos obtenidos con esta técnica de reconstrucción en defectos óseos segmentarios infectados de fémur y tibia, caracterizar los defectos tratados y describir los diferentes aspectos de la técnica quirúrgica.

Materiales y Métodos: Analizamos a 24 pacientes (14 hombres y 10 mujeres; edad promedio 36.16 años [rango 18-67]) tratados con la técnica de Masquelet, operados entre 2011 y 2016. El seguimiento promedio fue de 16.5 meses (rango 12-27) desde el segundo tiempo quirúrgico. Se analizaron el hueso afectado, la longitud del defecto (en cm), el tiempo de consolidación y el control del proceso infeccioso.

Resultados: La longitud del defecto óseo tratado fue, en promedio, de 5,7 cm (rango 3-12), fue superior a 4 cm en el 50% de los casos, el defecto óseo segmentario de mayor tamaño en la tibia fue de 12 cm y de 10 cm en el fémur. Se logró la consolidación ósea en todos los casos, en 4.5 meses. Un paciente presentó una recidiva del proceso infeccioso a los 12 meses de la consolidación.

Conclusiones: La técnica de Masquelet o de la membrana inducida ofrece una alternativa razonable y sencilla para un problema altamente desafiante como son los defectos óseos segmentario infectados. La tasa de consolidación es superior al 90% aun en casos complejos.


 

ABSTRACT

Introduction: Infected segmental bone defects are challenging conditions which require a complex treatment. The Masquelet technique is an alternative for these cases. The aim of this retrospective, multicenter study was to show the clinical and radiological outcomes achieved with the use of this reconstruction technique in infected femoral and tibial segmental defects in order to characterize the defects treated and describe different aspects of this surgical approach.

Methods: We analyzed 24 patients (14 men and 10 women; average age 36.16 years [range 18-67]) treated with the Masquelet technique between 2011 and 2016. The average follow-up was 16.5 months (range 12-27) from the second surgical stage. We analyzed the affected bone, defect length (cm), consolidation time and infection control.

Results: Average length of treated bone defect was 5.7 cm (range 3-12), exceeding 4 cm in 50% of the cases. The largest segmental bone defect was 12 cm at the tibia and 10 cm at the femur. Bone consolidation was achieved in all cases, on an average of 4.5 months. One patient presented a recurrent infection 12 months after successful consolidation.

Conclusions: The Masquelet technique, or induced membrane technique, offers a reasonable and simple alternative to a highly challenging problem, such as infected segmental bone defects, achieving a consolidation rate greater than 90% even in complex cases.


Palabras clave


Defecto óseo segmentario; defecto óseo infectado; fémur; tibia; técnica de Masquelet; segmental bone defect; infected bone defect; femur; tibia; Masquelet technique

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Referencias


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DOI: http://dx.doi.org/10.15417/issn.1852-7434.2019.84.1.853

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