摘要目的:比较Masquelet技术治疗骨缺损时体内制作与体外制作骨水泥间隔的应用效果。方法:回顾性分析2009年1月至2019年8月无锡市第九人民医院骨科应用Masquelet技术治疗128例骨缺损患者资料。男74例，女54例；年龄13~77岁。外伤性骨缺损54例，感染性骨缺损74例。按骨水泥间隔制作方式不同分为：体内组76例（在骨水泥的面团期植入骨缺损部位，在体内制作塑形成与缺损大小相匹配或略大于周径的圆柱状结构）和体外组52例（在骨水泥的面团期在体外制作圆柱状、块状、珠链或球形等结构骨水泥间隔，待自然凝固并且温度降为室温后植入骨缺损部位）。比较两组骨水泥间隔填充时间、骨愈合时间、延迟愈合发生率、感染控制率、间隔取出需要时间和诱导膜或断端骨损伤发生率，同时末次随访时上肢功能障碍评定量表（DASH）评定上肢功能，按Paley方法评定下肢分级，并进行两组间比较。结果:两组患者性别、年龄、感染情况、合并伤、糖尿病史和手术次数等比较差异均无统计学意义（ P>0.05），具有可比性。所有患者术后获12~50个月（平均18.6个月）随访。与体外组比较，体内组上、下肢和大、小段骨缺损的骨水泥间隔填充时间、骨愈合时间、延迟愈合发生率、感染控制率和肢体功能恢复优良率差异均无统计学意义（ P>0.05），而体内组上、下肢和大、小段骨缺损的间隔取出需要时间[（3.6±1.0）、（4.1±1.1）、（4.0±1.1）、（3.9±1.0）min]和诱导膜或断端骨损伤发生率[48.1%（13/27）、73.5%（36/49）、82.6%（39/46）、66.7%（20/30）]均大于体外组的间隔取出时间[均为（0.4±0.2）min]和诱导膜或断端骨损伤发生率[3.2%（1/31）、9.5%（2/21）、0（0/21）、0（0/31）]，差异均有统计学意义（ P<0.05）。 结论:Masquelet技术治疗骨缺损时体内制作与体外制作骨水泥间隔的疗效相近。体内制作更适合下肢、长段和稳定性不佳的骨缺损，但间隔不容易取出、容易损伤诱导膜或断端骨组织；体外制作多种形状间隔更适合部分性、小段和上肢的骨缺损。

abstractsObjective:To compare in vivo versus in vitro fabrication of bone cement spacers in the treatment of bone defects by Masquelet technique. Methods:The data of 128 patients were analyzed retrospectively who had been treated for bone defects by Masquelet technique at Department of Orthopedics, Wuxi No. 9 People’s Hospital from January to August 2019. They were 74 males and 54 females, aged from 13 to 77 years. Their bone defects were traumatic in 54 cases and infectious in 74 cases. In 76 of them ( in vivo group), after a bone cement spacer was implanted into a bone defect during its dough phase, it was fabricated in vivo to form a cylindrical structure which was as large as or slightly larger than the defect size. In the other 52 cases ( in vitro group), before a bone cement spacer was implanted into a bone defect, it was fabricated in vivo during its dough phase into a cylindrical or block or bead chain or spherical form which was naturally solidificated at room temperature. The 2 groups were compared in terms of spacer filling time, bone healing time, delayed healing rate, infection control rate, spacer removal time, incidence of induced membrane or broken end bone lesion, as well as upper limb function evaluated by the Disability of the Arm, Shoulder and Hand Questionnaire (DASH) and the Paley lower limb grading at the last follow-up. Results:The 2 groups were comparable because there was no significant difference between them in gender, age, ratio of infected to non-infected cases, combined injuries, comorbidities or number of operations ( P>0.05). All the patients were followed up for 12 to 50 months (mean, 18.6 months). There were no significant differences between the 2 groups in spacer filling time, bone healing time, delayed healing rate, infection control rate or functional recovery for upper or lower limbs or for large or small bone defects (all P>0.05). In the in vivo group, for upper and lower limbs and for large and small bone defects respectively, the spacer removal time [(3.6±1.0) min, (4.1±1.1) min, (4.0±1.1) min and (3.9±1.0) min] and the incidence of induced membrane or broken end bone lesion [48.1%(13/27), 73.5%(36/49), 82.6%(39/46) and 66.7%(20/30)] were significantly longer or higher than those in the in vitro group [all (0.4±0.2) min; 3.2%(1/31), 9.5%(2/21), 0 (0/21) and 0 (0/31)] (all P<0.05). Conclusions:In the treatment of bone defects by Masquelet technique, in vivo and in vitro fabrication of bone cement spacers may lead to similar therapeutic effects. In vivo fabrication may be more suitable for lower limb, large or unstable bone defects but the spacer is not easy to remove and the induced membrane or bone ends are likely to get injured while in vitro fabrication may be more suitable for partial, small or upper limb defects because it may produce a variously shaped spacer.