Department of Orthopedics, Grant Medical Center, Columbus, OH, USA.
J Am Acad Orthop Surg. 2012 Mar;20(3):142-50. doi: 10.5435/JAAOS-20-03-142.
Multiple surgeries are often required to manage segmental bone loss because of the complex mechanics and biology involved in reconstruction. These procedures can lead to prolonged recovery times, poor patient outcomes, and even delayed amputation. A two-stage technique uses induced biologic membranes with delayed placement of bone graft to manage this clinical challenge. In the first stage, a polymethyl methacrylate spacer is placed in the defect to produce a bioactive membrane, which appears to mature biochemically and physically 4 to 8 weeks after spacer placement. In the second, cancellous autograft is placed within this membrane and, via elution of several growth factors, the membrane appears to prevent graft resorption and promote revascularization and consolidation of new bone. Excellent clinical results have been reported, with successful reconstruction of segmental bone defects >20 cm.
由于涉及复杂的力学和生物学，通常需要多次手术来治疗节段性骨缺失，以进行重建。这些手术可能导致恢复时间延长、患者预后不良，甚至延迟截肢。两阶段技术使用诱导生物膜并延迟放置骨移植物来应对这一临床挑战。在第一阶段，将聚甲基丙烯酸甲酯间隔物放置在缺陷处以产生生物活性膜，在间隔物放置后 4 至 8 周，该膜似乎在生化和物理上成熟。在第二阶段，将松质自体移植物放置在该膜内，通过洗脱几种生长因子，该膜似乎可以防止移植物吸收，并促进新骨的再血管化和巩固。已有报道称，该技术取得了优异的临床效果，成功重建了>20cm 的节段性骨缺损。
