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采用诱导膜技术修复创伤性骨缺损:11例初步结果

Reconstruction of traumatic bone loss using the induced membrane technique: preliminary results about 11 cases.

作者信息

Kombate Noufanangue Kanfitine, Walla Atchi, Ayouba Gamal, Bakriga B Moïse, Dellanh Yaovi Yannick, Abalo Anani Grégoire, Dossim Assang Michel

机构信息

Orthopedic and Traumatology Department of Afagnan Saint-Jean-de- Dieu Hospital, Lome-Togo, P.O Box 1170, Africa.

Orthopedic and Traumatology Department of Sylvanus Olympio Teaching Hospital, Lome-Togo, P.O Box 57, Africa.

出版信息

J Orthop. 2017 Jul 13;14(4):489-494. doi: 10.1016/j.jor.2017.06.009. eCollection 2017 Dec.

Abstract

INTRODUCTION

The use of Masquelet technique is a serious option to consider for biologic reconstruction of severe bone loss. Here is exposed a continuous and prospective study on bone loss management using that technique. The aims of this study were to assess epidemiology of bone loss due either to trauma or to non-unions and to give preliminary results.

PATIENTS AND METHODS

It was a prospective study from April 2015 to december 2016 involving patients treated using the induced membrane technique for a diaphyseal bone defect due either to trauma or non-unions. AO plates or Orthofix external fixators were used for osteosynthesis. Bone healing was radiologically assessed and any complications were listed.

RESULTS

During the study period, 11 patients were treated using the induced membrane technique. There were 8 males and 3 females. Their mean age was 40.45 years (21-59). The skeletal segments concerned were 2 humerus, 6 femurs and 3 tibias with a mean bone defect length of 4,45 cm (2.5-8). The delay between reconstruction and trauma was 8 months (20 days - 3 years). After a mean follow-up of 6.54 months (3-11) six patients presented a good radiological healing (4 femurs, 2 humerus) whereas in four patients, autograft osteointegration was still ongoing (2 femurs, 2 tibias). A tibia secondary infection was observed in a patient with the graft partial resorption. In another patient, an initial gangrene lead to a leg amputation.

CONCLUSION

The induced membrane technique is an excellent option for bone defect reconstruction compared to other usual bone graft techniques. It helped us to manage large bone loss in various skeletal segments.

摘要

引言

对于严重骨缺损的生物重建,Masquelet技术的应用是一个值得认真考虑的选择。本文展示了一项关于使用该技术进行骨缺损管理的连续性前瞻性研究。本研究的目的是评估创伤或骨不连导致的骨缺损的流行病学情况,并给出初步结果。

患者与方法

这是一项从2015年4月至2016年12月的前瞻性研究,纳入了因创伤或骨不连导致骨干骨缺损并采用诱导膜技术治疗的患者。使用AO钢板或Orthofix外固定器进行骨固定。通过影像学评估骨愈合情况,并列出所有并发症。

结果

在研究期间,11例患者采用诱导膜技术进行治疗。其中男性8例,女性3例。他们的平均年龄为40.45岁(21 - 59岁)。受累骨骼节段包括2例肱骨、6例股骨和3例胫骨,平均骨缺损长度为4.45厘米(2.5 - 8厘米)。重建与创伤之间的间隔时间为8个月(20天 - 3年)。平均随访6.54个月(3 - 11个月)后,6例患者影像学显示愈合良好(4例股骨,2例肱骨),而4例患者自体骨仍在进行骨整合(2例股骨,2例胫骨)。1例患者出现胫骨继发感染,伴有移植物部分吸收。另1例患者最初发生坏疽,导致腿部截肢。

结论

与其他常用骨移植技术相比,诱导膜技术是骨缺损重建的极佳选择。它有助于我们处理不同骨骼节段的大面积骨缺损。

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