目的 比较诱导膜技术中两种不同清创方式治疗胫骨慢性骨髓炎的疗效。 方法 对2016年7月至2023年12月收治的52例Cierny-Mader Ⅳ型A/B型慢性胫骨骨髓炎患者开展回顾性研究，其中2020年前诊治5例患者，2020年后诊治47例患者。按手术方式分为局部病灶清除组（局灶组，28例）与en bloc截骨组（截骨组，24例），评估两组患者的手术时间、切口长度、术中失血量、住院时长围术期数据，并通过美国特种外科医院（HSS）膝关节评分、美国足踝外科协会（AOFAS）踝-后足评分、关节活动度测量（膝关节屈伸/足跖屈-背伸）以及复发率、Paley感染性骨缺损骨愈合评级标准，系统分析术后6、12个月及末次随访的临床疗效。 结果 局灶组术中失血量、手术时间、住院时间、术后6、12个月AOFAS评分、术后6、12个月的HSS评分优于截骨组，差异有统计学意义（P < 0.05），截骨组术后6、12个月以及末次随访时Paley评级优于局灶组，差异有统计学意义（P < 0.05）；纵向对比显示，两组患者术后1、6个月及末次随访时的AOFAS评分、HSS评分及足/膝关节活动度均较术前显著改善（P < 0.05）；而组间横向对比显示，末次随访时膝、踝关节功能评分及术后6、12个月、末次随访时的关节活动度参数差异均无统计学意义（P > 0.05），截骨组术后感染复发率及并发症情况明显低于局灶组。 结论 En bloc截骨结合诱导膜技术可以更彻底地进行清创，减少二次清创次数及术后复发率，降低术后并发症，促进骨愈合。

Objective To compare of the efficacy of two distinct debridement techniques in membrane induction therapy for chronic tibial osteomyelitis. Methods A retrospective study was conducted on 52 patients with Cierny-Mader type IV A/B chronic tibial osteomyelitis who were treated at the Third Affiliated Hospital of Zunyi Medical University between July 2016 and December 2023. Five patients were diagnosed and treated before 2020， while 47 were managed from 2020 onward. Patients were divided into two groups： a local debridement group （n = 28） and an en bloc osteotomy group （n = 24）. Perioperative outcomes—including operative time， incision length， intraoperative blood loss， and length of hospital stay—were assessed， along with clinical efficacy at 6 months， 12 months， and final follow-up. Clinical outcomes were evaluated using the Hospital for Special Surgery （HSS） knee score， the American Orthopaedic Foot & Ankle Society （AOFAS） ankle-hindfoot score， joint range of motion （knee flexion-extension and ankle plantarflexion-dorsiflexion）， recurrence rate， and the Paley classification for infectious bone defects. Results The local debridement group exhibited significantly less intraoperative blood loss （P < 0.05）， shorter operative time （P < 0.05）， and reduced hospital stay （P < 0.05）， as well as higher AOFAS and HSS scores at both 6 and 12 months postoperatively （P < 0.05）. In contrast， the osteotomy group demonstrated superior Paley classification outcomes at 6 months， 12 months， and final follow-up （P < 0.05）， along with lower rates of infection recurrence. Longitudinal analysis indicated significant improvements in AOFAS scores， HSS scores， and joint mobility over time in both groups （P < 0.05）. However， no statistically significant differences were observed between groups in terms of functional scores or joint mobility parameters at final follow-up （P > 0.05）. Conclusion En bloc osteotomy combined with the induced membrane technique （Masquelet technique） enables more comprehensive debridement， minimizes the necessity for repeated surgical interventions， reduces postoperative complications， lowers the risk of recurrence， and promotes enhanced bone healing.