Aurégan Jean-Charles, Bégué Thierry, Rigoulot Guillaume, Glorion Christophe, Pannier Stéphanie
Department of Orthopaedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, University Paris Sud, 157 rue de la Porte de Trivaux, 92140, Clamart, France.
Department of Orthopaedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, University Paris Sud, 157 rue de la Porte de Trivaux, 92140, Clamart, France.
Injury. 2016 Dec;47 Suppl 6:S62-S67. doi: 10.1016/S0020-1383(16)30841-5.
The induced membrane technique was designed by Masquelet et al. to address segmental bone defects of critical size in adults. It has been used after bone defects of traumatic, infectious and tumoral origin with satisfactory results. Recently, it has been used in children but, after an initial enthusiasm, several cases of failure have been reported. The purpose of this study was to assess the success rate and the risk factors of failure of the induced membrane for children. We conducted a systematic review of all the studies reporting the results of the induced membrane technique to address bone defects of critical size in children. Our primary outcome was the success rate of the technique defined as a bone union before any iterative surgery. Our secondary outcomes were the complications and the risk factors of failure. We searched Medline via Pubmed, EMBASE and the Cochrane Library. Twelve studies, including 69 patients, met the inclusion criteria. There were 41 boys and 28 girls. Mean age at surgery was 10 years. Mean size of resection was 12.38 cm and the mean time between the two stages was 5.86 months. Mean rate of bone union after the two stages of the induced membrane technique was 58% (40/69) but this rate increased to 87% after revision surgeries (60/69). Main complications were non-unions (19/69), lysis of the graft (6/69) and fractures of the bone graft (6/69). Only 1/69 deep infection was reported. Other non specific complications were regularly reported such limb length discrepancies, joint stiffness and protruding wires. Risk factor of failure that could be suspected comprised the resection of a malignant tumour, a bone defect located at the femur, a wide resection, a long time between the two stages, an unstable osteosynthesis and a bone graft associating autograft to other graft materials. The induced membrane technique is suitable for bone defects of critical size in children. It is a reliable technique with no need of micro vascular surgery. However, we found several risk factors of failure for the use of the induced membrane technique to address segmental bone defect of critical size in children.
诱导膜技术由马斯克莱等人设计，用于解决成人临界尺寸的节段性骨缺损问题。它已被应用于创伤性、感染性和肿瘤性骨缺损后，效果令人满意。最近，该技术也被用于儿童，但在经历了最初的热情之后，已有数例失败的报道。本研究的目的是评估儿童诱导膜技术的成功率和失败风险因素。我们对所有报告诱导膜技术治疗儿童临界尺寸骨缺损结果的研究进行了系统评价。我们的主要结局指标是该技术的成功率，定义为在任何再次手术前实现骨愈合。次要结局指标是并发症和失败风险因素。我们通过PubMed、EMBASE和Cochrane图书馆检索了Medline。12项研究，包括69例患者，符合纳入标准。其中有41名男孩和28名女孩。手术时的平均年龄为10岁。平均切除长度为12.38厘米，两期手术之间的平均时间为5.86个月。诱导膜技术两期手术后的平均骨愈合率为58%（40/69），但在翻修手术后该率升至87%（60/69）。主要并发症为骨不连（19/69）、植骨溶解（6/69）和骨移植骨折（6/69）。仅报告了1例（1/69）深部感染。还经常报告其他非特异性并发症，如肢体长度差异、关节僵硬和钢丝外露。可能被怀疑的失败风险因素包括恶性肿瘤切除、股骨部位的骨缺损、广泛切除、两期手术之间的时间长、骨固定不稳定以及自体骨与其他移植材料联合的骨移植。诱导膜技术适用于儿童临界尺寸的骨缺损。它是一种可靠的技术，无需微血管手术。然而，我们发现了使用诱导膜技术治疗儿童临界尺寸节段性骨缺损的几个失败风险因素。
