Service d'orthopédie pédiatrique, Hôpital Nord, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 1, France.
Orthop Traumatol Surg Res. 2013 Nov;99(7):837-43. doi: 10.1016/j.otsr.2013.05.005. Epub 2013 Sep 23.
In pediatrics, Masquelet's induced membrane reconstructive technique has mainly been used in the context of cancer surgery reconstruction or congenital pseudarthrosis of the tibia. This retrospective study consisted of a series of pediatric patients where bone defects were reconstructed with this technique.
Between 2006 and 2011, 14 children underwent bone reconstruction using this technique in the context of trauma, tumor resection or congenital pseudarthrosis. The mean age was 10.6years (range: 12 to 17years) at the time of reconstruction. The length of the defect to be reconstructed relative to the length of the bone (index of reconstruction, expressed as a percentage) and bone healing was evaluated on standard radiographs. Complications were recorded.
The mean index of reconstruction was 32.8% (range: 13.9 to 51%). The mean follow-up was 30months (range: 1 to 63). Bone union was achieved in 9.5months (range: 2 to 25). Complications mainly consisted of non-union in 35% of cases, which consolidated after grafting and rigid fixation. Two cases of wound dehiscence were noted. Massive graft resorption occurred in a single case.
A technical error was identified in each non-union case (insufficient cement overlap of the bone ends or fixation not stiff enough). These long defects required a large volume of autograft, which constitutes the limiting factor especially in very young children. We used allograft bone chips or a tibial bone strut to increase the graft volume in the largest reconstructions. In this pediatric-only series, an average of one-third of the bone length was successfully reconstructed. Although the technique appears simple, it must be performed rigorously to ensure the cement sufficiently overlaps the bone ends and the defect is properly stabilized to prevent non-union, which is the main complication.
Level IV (retrospective study).
在儿科领域，Masquelet 诱导膜重建技术主要应用于癌症手术重建或先天性胫骨假关节。本回顾性研究纳入了一系列采用该技术进行骨缺损重建的儿科患者。
2006 年至 2011 年，14 例儿童因创伤、肿瘤切除或先天性假关节而行该技术骨重建。重建时的平均年龄为 10.6 岁（12 岁至 17 岁）。以百分比表示的重建骨相对骨长度的缺损长度（重建指数）和骨愈合情况在标准 X 线片上进行评估。记录并发症。
平均重建指数为 32.8%（13.9%至 51%）。平均随访 30 个月（1 个月至 63 个月）。9.5 个月（2 个月至 25 个月）达到骨愈合。并发症主要包括 35%的病例发生骨不连，经植骨和刚性固定后愈合。有 2 例伤口裂开。1 例发生大量移植物吸收。
每个骨不连病例均存在技术错误（骨端水泥覆盖不足或固定不够牢固）。这些长骨缺损需要大量自体骨，尤其是在非常年幼的儿童中，这是一个限制因素。我们在最大的重建中使用同种异体骨屑或胫骨骨支撑物来增加移植物体积。在这个仅有儿科患者的系列中，平均三分之一的骨长度成功重建。尽管该技术看似简单，但必须严格执行，以确保水泥充分覆盖骨端，且缺损得到适当固定，以防止主要并发症骨不连。
IV 级（回顾性研究）。
