Замещение дефекта бедренной кости, пораженного посттравматическим остеомиелитом, неваскуляризированным малоберцовым аутотрансплантатом: клинический случай

Abstract

Replacement of extensive defects of tubular bones against the background of osteomyelitis remains an urgent problem today. The existing methods of replacing such defects by the method of bilocal osteosynthesis with the Ilizarov apparatus or the use of a free fibular autograft are not always applicable. We present a clinical case of the use of a combined Masquelet’s induced membrane technique with bone autoplasty by fibular graft and the use of the Ilizarov frame. A 33-year-old patient was injured in December 2015 as a result of a traffic accident. Subsequently, the development of osteomyelitis has been noted. As a result of surgery and the course of osteomyelitis, there was formed an extensive femoral defect of up to 9.5 cm. Next, the first stage of a two-stage surgical treatment was performed – Sequestrnecrectomy, remounting of the Ilizarov frame, installation of a temporary cement spacer with an antibiotic into the formed bone defect of the right femur using the Masquelet technique. After 4 months, the second stage of surgical treatment was performed – Free autograft of a fragment of the fibula in order to replace a bone defect of the right femur. In order to stimulate and improve the reparative and integrative processes of the bone autograft, PRP therapy was performed 10 months after the last surgery. 21 months after the second stage of surgical treatment, the consolidation of a free fragment of the fibula was established with the help of an X-ray, and the Ilizarov frame was dismantled. 48 months after the second stage of the surgery, the functional condition is satisfactory, the patient moves with a full support load on the right lower limb. In the presented clinical case, the combination of Masquelet technique, free fibular autograft and osteosynthesis by Ilizarov frame allowed to achieve satisfactory functional results. Key words: Ilizarov frame, bone defect, reconstruction, free bone autograft, Masquelet, induced membrane.