Service de chirurgie orthopédique, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France.
Clinique de l'Estrée, 35, rue d'Amiens, 93240 Stains, France.
Orthop Traumatol Surg Res. 2019 Feb;105(1):159-166. doi: 10.1016/j.otsr.2018.11.012. Epub 2019 Jan 11.
The induced membrane technique for bone defect reconstruction is now well recognized, and short-term results for bone healing are consistent between published reports.
To assess very long-term functional results in post-traumatic reconstruction using the induced membrane technique.
Results for 18 patients undergoing bone defect reconstruction by induced membrane were retrospectively analyzed at 10 to 22years' follow-up. Initial lesions were multitissue with infection in 14 cases. Reconstruction concerned the tibia in 14 cases, and the humerus, elbow, radius or ulna in 1 case each. Soft-tissue reconstruction was performed in 17 cases, by free flap (n=8) or pedicle flap (n=9). Fixation used a single-plane external fixator in 15 cases, screwed plate in 1 case (humerus), or intramedullary nail in 1 case (ulna). There was 1 crossover from external fixator to internal plate fixation (radius). Assessment comprised radiology, functional assessment, clinical examination and patient satisfaction. All patients were followed up in individual consultation.
Eight of the 14 patients with lower limb lesions had unrestricted walking distance; 4 resumed leisure sports. Limb shortening ranged from 0.5 to 4cm and was well-tolerated, although dorsiflexion was abolished or limited in most cases. Several patients underwent second procedures to improve limb function: ankle fusion, Achilles lengthening, tendon transfer, or realignment osteotomy. Radiology found a neotubular aspect, indicating peripheral densification and central resorption. Despite the multiple procedures, no patients regretted the original limb-conserving surgery. All reported that it took 2 to 3years after consolidation and resumption of walking to achieve stable final functional improvement. No recurrent sepsis in the reconstruction zone was found.
The present results encourage implementing limb-conserving strategies in young patients after severe multitissue limb trauma, on condition that lesions are properly assessed, notably in terms of infection, and that the reconstruction protocol is feasible and has the patient's consent.
IV, retrospective series.
诱导膜技术在骨缺损重建中已得到广泛认可，其短期骨愈合效果在已发表的报告中较为一致。
评估诱导膜技术在创伤后重建中的长期功能结果。
对 18 例采用诱导膜进行骨缺损重建的患者进行回顾性分析，随访时间为 10 至 22 年。初始病变为多组织感染 14 例。重建涉及胫骨 14 例，肱骨、肘部、桡骨或尺骨各 1 例。17 例进行软组织重建，采用游离皮瓣（n=8）或带蒂皮瓣（n=9）。15 例采用单平面外固定架固定，1 例（肱骨）采用螺钉板固定，1 例（尺骨）采用髓内钉固定。1 例（桡骨）从外固定架转换为内钢板固定。评估包括影像学、功能评估、临床检查和患者满意度。所有患者均在单独的咨询中进行随访。
14 例下肢病变患者中，8 例行走距离不受限制；4 例恢复休闲运动。肢体缩短范围为 0.5 至 4cm，患者耐受良好，尽管大多数患者背屈受限或消失。一些患者接受了二次手术以改善肢体功能：踝关节融合、跟腱延长、肌腱转移或矫正性截骨。影像学检查发现新的管状外观，表明周围致密化和中央吸收。尽管进行了多次手术，但没有患者对保留肢体的原始手术表示后悔。所有患者均报告称，在骨愈合和恢复行走后，需要 2 至 3 年才能实现稳定的最终功能改善。在重建区域未发现复发性感染。
目前的结果鼓励在年轻患者发生严重多组织肢体创伤后采用保留肢体的策略，前提是对病变进行适当评估，特别是感染情况，并确保重建方案可行且患者同意。
IV，回顾性系列研究。
