Luangphakdy Viviane, Elizabeth Pluhar G, Piuzzi Nicolás S, D'Alleyrand Jean-Claude, Carlson Cathy S, Bechtold Joan E, Forsberg Jonathan, Muschler George F
Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, USA.
Clin Orthop Relat Res. 2017 Oct;475(10):2575-2585. doi: 10.1007/s11999-017-5420-8. Epub 2017 Jun 20.
The Masquelet-induced-membrane technique is a commonly used method for treating segmental bone defects. However, there are no established clinical standards for management of the induced membrane before grafting.
QUESTIONS/PURPOSES: Two clinically based theories were tested in a chronic caprine tibial defect model: (1) a textured spacer that increases the induced-membrane surface area will increase bone regeneration; and (2) surgical scraping to remove a thin tissue layer of the inner induced-membrane surface will enhance bone formation.
Thirty-two skeletally mature female goats were assigned to four groups: smooth spacer with or without membrane scraping and textured spacer with or without membrane scraping. During an initial surgical procedure (unilateral, left tibia), a defect was created excising bone (5 cm), periosteum (9 cm), and muscle (10 g). Segments initially were stabilized with an intramedullary rod and an antibiotic-impregnated polymethylmethacrylate spacer with a smooth or textured surface. Four weeks later, the spacer was removed and the induced-membrane was either scraped or left intact before bone grafting. Bone formation was assessed using micro-CT (total bone volume in 2.5-cm central defect region) as the primary outcome; radiographs and histologic analysis as secondary outcomes, with the reviewer blinded to the treatment groups of the samples being assessed 12 weeks after grafting. All statistical tests were performed using a linear mixed effects model approach.
Micro-CT analysis showed greater bone formation in defects with scraped induced membrane (mean, 3034.5 mm; median, 1928.0 mm; quartile [Q]1-Q3, 273.3-2921.1 mm) compared with defects with intact induced membrane (mean, 1709.5 mm; median, 473.8 mm; Q1-Q3, 132.2-1272.3 mm; p = 0.034). There was no difference in bone formation between textured spacers (mean, 2405.5 mm; median, 772.7 mm; Q1-Q3, 195.9-2743.8 mm) and smooth spacers (mean, 2473.2 mm; median, 1143.6 mm; Q1-Q3, 230.2-451.1 mm; p = 0.917).
Scraping the induced-membrane surface to remove the innermost layer of the induced-membrane increased bone regeneration. A textured spacer that increased the induced-membrane surface area had no effect on bone regeneration.
Scraping the induced membrane during the second stage of the Masquelet technique may be a rapid and simple means of improving healing of segmental bone defects, which needs to be confirmed clinically.
Masquelet诱导膜技术是治疗节段性骨缺损常用的方法。然而，在植骨前诱导膜的处理尚无既定的临床标准。
问题/目的：在慢性山羊胫骨缺损模型中验证两种基于临床的理论：（1）增加诱导膜表面积的带纹理间隔物会促进骨再生；（2）手术刮除诱导膜内表面的薄层组织会增强骨形成。
32只骨骼成熟的雌性山羊被分为四组：带或不带膜刮除的光滑间隔物组以及带或不带膜刮除的带纹理间隔物组。在初次手术（左侧单胫骨）时，切除一段骨（5厘米）、骨膜（9厘米）和肌肉（10克）制造缺损。最初用髓内棒和表面光滑或带纹理的含抗生素聚甲基丙烯酸甲酯间隔物固定节段。四周后取出间隔物，在植骨前刮除或不刮除诱导膜。使用微型CT（2.5厘米中央缺损区域的总骨体积）评估骨形成作为主要结果；X线片和组织学分析作为次要结果，在植骨12周后评估样本时，评估者对治疗组情况不知情。所有统计检验采用线性混合效应模型方法。
微型CT分析显示，与诱导膜完整的缺损（均值1709.5毫米；中位数473.8毫米；四分位数[Q]1-Q3，132.2-1272.3毫米）相比，诱导膜刮除的缺损骨形成更多（均值3034.5毫米；中位数1928.0毫米；Q1-Q3，273.3-2921.1毫米；p = 0.034）。带纹理间隔物（均值2405.5毫米；中位数772.7毫米；Q1-Q3，195.九-2743.8毫米）与光滑间隔物（均值2473.2毫米；中位数1143.6毫米；Q1-Q3，230.2-451.1毫米；p = 0.917）之间骨形成无差异。
刮除诱导膜表面以去除诱导膜最内层可增加骨再生。增加诱导膜表面积的带纹理间隔物对骨再生无影响。
在Masquelet技术第二阶段刮除诱导膜可能是改善节段性骨缺损愈合的一种快速简便方法，这需要临床进一步证实。
