Department of Pediatric Surgery, Hautepierre Teaching Hospital Center, Strasbourg, France.
Orthop Traumatol Surg Res. 2012 Feb;98(1):97-102. doi: 10.1016/j.otsr.2011.11.001. Epub 2012 Jan 12.
Among bone reconstruction techniques, the induced membrane technique, proposed in 1986 by Masquelet, has rarely been studied or evaluated in the surgical literature until recently. The 2010 French Society of Orthopaedic Surgery and Traumatology (SoFCOT) Annual Convention symposium was the occasion to evaluate a large cases series having used this technique.
This retrospective study included 84 posttraumatic diaphyseal long bone reconstructions using the induced membrane technique (1988-2009). The series included 79 men and five women (mean age 32-year-old). In 89% of cases, the initial trauma was an open fracture. The leg was involved in 70% of cases. The mean delay between the accident and treatment of bone defects (BD) was 8 months. In 50% of the cases, infection was present. Bone defects were larger than 5cm in 57% of the cases.
Union was obtained in 90% of cases, a mean 14.4 months after the first stage of the reconstruction. A mean 6.11 interventions were necessary to obtain union. Malalignment was present in 17% of cases. Delayed interventions to correct deformities mostly of the foot were necessary in 16% of the cases. Eight failures (10%) involved severe leg traumas associating extensive bone defects, soft tissue lesions and infection and required amputation in six cases.
This series emphasizes the severity of open fractures of the leg, especially those with primary or secondary infection. The induced membrane technique has been shown to be effective in treating bone defects, regardless of their magnitude. In a two-step procedure, this simple but demanding technique, which may be more complicated when repair of soft tissue is necessary, provides successful treatment in case of initial infection and fulfills the goal of controlling infection before bone reconstruction. Moreover, the induced membrane technique can be integrated in hybrid reconstruction procedures.
Level IV. Retrospective study.
在骨重建技术中，Masquelet 于 1986 年提出的诱导膜技术，直到最近才在外科文献中得到研究和评估。2010 年法国矫形外科和创伤外科学会（SoFCOT）年会专题讨论会对使用该技术的大量病例进行了评估。
本回顾性研究纳入了 84 例创伤后骨干节段性骨缺损应用诱导膜技术（1988 年至 2009 年）的病例。该系列包括 79 名男性和 5 名女性（平均年龄 32 岁）。89%的初始创伤为开放性骨折。70%的病例累及下肢。骨缺损治疗的事故与感染之间的平均延迟时间为 8 个月。50%的病例存在感染。57%的病例骨缺损大于 5cm。
90%的病例获得了愈合，第一次重建后平均 14.4 个月。平均需要 6.11 次干预才能获得愈合。17%的病例存在对线不良。16%的病例需要延迟干预以纠正足部畸形。8 例（10%）失败病例涉及严重的腿部创伤，合并广泛的骨缺损、软组织损伤和感染，6 例需要截肢。
本系列强调了下肢开放性骨折的严重程度，尤其是那些合并原发性或继发性感染的病例。诱导膜技术已被证明对治疗骨缺损有效，无论其严重程度如何。在两步手术中，这种简单但要求较高的技术，在需要修复软组织时可能更为复杂，在初始感染时可提供成功的治疗，并在骨重建前达到控制感染的目标。此外，诱导膜技术可整合于混合重建程序中。
IV 级。回顾性研究。
