Zappaterra T, Ghislandi X, Adam A, Huard S, Gindraux F, Gallinet D, Lepage D, Garbuio P, Tropet Y, Obert L
EA 4268 innovation, imagerie, ingénierie et intervention en santé « I4S », IFR 133 Inserm, service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU Jean-Minjoz Besançon, université de Franche-Comté, 3, boulevard Fleming, 25000 Besançon, France.
Chir Main. 2011 Sep;30(4):255-63. doi: 10.1016/j.main.2011.06.005. Epub 2011 Jul 16.
Bone defect in the upper limb remain infrequent with few reported in the literature. Their reconstruction raises the problem of bone union of non weight-bearing segments as well as the function of adjacent joints. We report a monocentric continuous series of nine patients treated with the induced membrane technique (Masquelet technique).
Nine patients with a mean age of 39.2 years (17-69) presented with a bone defect of the humerus (six cases) or one of two bones (three cases). Diaphyseal (six cases) or metaphyseal (three cases) defects were secondary to trauma in three patients, to non-union in four others and following tumors for the other two. The mean defect was 5.1cm (2.5-9). Reconstruction was done by initial filling using a spacer in cement, followed by a cancellous bone graft within the induced membrane. BMP's growth factor was used in two cases.
Bone union was achieved in eight out of nine cases with a follow-up of 23 months (8-52) after the first stage, and 17 months (6-49) following filling by the graft. One patient did not want the second stage done before one year. The failure was in a very non-compliant patient who had a bone substitute associated with aBMP. Two septic non-unions were cured. Shoulder and elbow functional outcomes were comparable to the controlateral side for humeral defects; pronosupination decreased by 17% for the cases of reconstruction of two bones.
The technique of the induced membrane allows filling of a large bone defect, while avoiding vascularised bone autografts and their morbidity. It requires two procedures but can be used in emergency or after failure of other interventions. It is a reliable, and reproducible technique where the only limit is the cancellous bone stock. Following the series of Masquelet, Apard and Stafford in the lower limb, and the series of Flamans in the hand, this is the first report of reconstruction of defect in the upper limb using this technique.
上肢骨缺损较为罕见，文献报道较少。其重建引发了非负重节段骨愈合以及相邻关节功能的问题。我们报告了一组采用诱导膜技术（Masquelet技术）治疗的9例单中心连续病例。
9例患者平均年龄39.2岁（17 - 69岁），存在肱骨骨缺损（6例）或两根骨头之一的骨缺损（3例）。骨干（6例）或干骺端（3例）缺损在3例患者中继发于创伤，4例继发于骨不连，另2例继发于肿瘤。平均缺损为5.1厘米（2.5 - 9厘米）。重建首先使用骨水泥间隔物进行初始填充，随后在诱导膜内植入松质骨移植。2例使用了骨形态发生蛋白（BMP）生长因子。
9例中有8例实现骨愈合，第一阶段后随访23个月（8 - 52个月），移植填充后随访17个月（6 - 49个月）。1例患者在1年之前不想进行第二阶段手术。失败发生在1例极不配合的患者，其使用了与BMP相关的骨替代物。2例感染性骨不连得以治愈。对于肱骨缺损，肩部和肘部功能结果与对侧相当；两根骨头重建的病例旋前旋后功能下降了17%。
诱导膜技术能够填充大的骨缺损，同时避免带血管的自体骨移植及其并发症。它需要两个步骤，但可用于急诊情况或其他干预失败后。这是一种可靠且可重复的技术，唯一的限制是松质骨储备。继Masquelet、Apard和Stafford在下肢的系列报道以及Flamans在手部的系列报道之后，这是首次使用该技术重建上肢缺损的报告。
