Orthopaedic and Traumatology Surgery, Hôpital Nord Marseille, 53, chemin des Bourrely, 13015 Marseille, France.
Orthopaedic and Traumatology Surgery, Hôpital Nord Marseille, 53, chemin des Bourrely, 13015 Marseille, France.
Orthop Traumatol Surg Res. 2020 Sep;106(5):789-796. doi: 10.1016/j.otsr.2019.08.022. Epub 2020 May 4.
Bone defects are challenging to treat surgically. The primary objective of our study was to compare the union rate and time to union between the tibia and femur when using the induced membrane technique. The secondary objective was to document how failures were managed.
This retrospective, single-center study involved 33 patients (23 men, 10 women) who were older than 18 years of age. They were treated surgically for a leg fracture or long bone nonunion (22 tibia, 11 femur) using the induced membrane technique between January 2011 and December 2016 and had a complete follow-up. The minimum follow-up was 1 year for fractures and 2 years for non-union cases. Bone union was defined as the presence of at least two cortices with bridging on two radiographic views and return to full weight bearing.
The mean patient age was 38.3±15.5 years (18-72). The mean bone defect size was 7.9±5.0cm (2.3-18.0). The mean follow-up was 3.3±1.8 years (1-7.2). The union rate was 61% (20 patients). The mean time to union was 10±6.4 months (3-23). The time to union was significantly longer in the tibia (11.6±6.9 months [3-23]) than in the femur (6.3±2.9 months [3.4-10.3]) (p=0.025). The failure rate did not differ between the tibia and femur. Nine of the 13 patients (69%) in which the treatment failed were reoperated; 7 of them underwent nonunion treatment (78%) and 2 underwent amputation (22%). The other 4 patients were waiting for an infection to resolve before being reoperated.
The induced membrane technique is an effective surgical procedure for large bone defects in both the tibia and femur. However, the time to union was shorter in the femur than the tibia in our cohort.
IV, retrospective study.
骨缺损的手术治疗具有挑战性。我们的主要研究目标是比较使用诱导膜技术时胫骨和股骨的愈合率和愈合时间。次要目标是记录失败的处理方式。
这是一项回顾性、单中心研究，共纳入 33 名年龄大于 18 岁的患者（23 名男性，10 名女性）。他们在 2011 年 1 月至 2016 年 12 月期间因腿部骨折或长骨骨不连（22 例胫骨，11 例股骨）接受了诱导膜技术手术治疗，且随访完整。骨折的最短随访时间为 1 年，骨不连的最短随访时间为 2 年。骨愈合定义为至少有 2 个皮质骨在 2 个影像学视图上桥接，并恢复完全负重。
患者平均年龄为 38.3±15.5 岁（18-72 岁）。平均骨缺损大小为 7.9±5.0cm（2.3-18.0cm）。平均随访时间为 3.3±1.8 年（1-7.2 年）。愈合率为 61%（20 例）。平均愈合时间为 10±6.4 个月（3-23 个月）。胫骨的愈合时间明显长于股骨（11.6±6.9 个月[3-23 个月]比股骨的 6.3±2.9 个月[3.4-10.3 个月]）（p=0.025）。胫骨和股骨的治疗失败率无差异。治疗失败的 13 名患者中有 9 名（69%）再次手术；其中 7 名接受了骨不连治疗（78%），2 名接受了截肢（22%）。另外 4 名患者正在等待感染痊愈后再次手术。
诱导膜技术是治疗胫骨和股骨大骨缺损的有效手术方法。然而，在我们的队列中，股骨的愈合时间比胫骨短。
IV，回顾性研究。
