诱导膜技术减少骨移植物吸收及影响体积变化的因素：40 例患者 120 例连续 CT 扫描分析。
Bone-Graft Resorption Reduced by the Induced Membrane Technique and Factors Affecting Volumetric Changes: An Analysis of 120 Serial Computed Tomographic Scans in 40 Patients.
机构信息
Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
Department of Orthopedic Surgery, University of California, San Diego, San Diego, California.
出版信息
J Bone Joint Surg Am. 2020 Jul 15;102(14):1269-1278. doi: 10.2106/JBJS.19.00804.
BACKGROUND
Little is known about the volumetric changes of grafted bone over time when using the induced membrane technique. This study investigates the volumetric changes of bone graft using serial computed tomographic (CT) scans following the induced membrane technique.
METHODS
Patients with critical-sized bone defects had serial CT scans after undergoing bone-grafting using the induced membrane technique. CT scans to evaluate the volume of bone graft were obtained immediately postoperatively and at 6 and 12 months. The change in the volume of bone graft was determined at 6 and 12 months postoperatively. Patient demographic characteristics, the location and composition of the bone graft, and the type of fixation construct were analyzed.
RESULTS
Forty patients met inclusion criteria. There were 27 tibiae and 13 femora with a mean size defect of 8.6 cm (range, 2.5 to 20.6 cm). Of these patients, 21 received autograft with cancellous bone graft and 19 received mixed autogenous bone with demineralized bone matrix (DBM) at a mean time of 17 weeks after the membrane formation. For the first 6 months, there was an overall osseous resorption of -9.9%. The overall graft volume from 6 to 12 months demonstrated an increase of osseous volume by +1.6%. For the entire 12-month period, there was a mean graft volume resorption of -8.3%. A correlation was found between the early volumetric changes of grafted bone and the percentage of DBM in the graft mixture. A correlation was also found between the late volumetric changes and the location of defect or the type of fixation.
CONCLUSIONS
At 1 year after use of the induced membrane technique for the treatment of a critical-sized bone defect, resorption of the grafted bone averaged -8.3%. The volumetric changes were influenced by the property of the grafted bone, the fixation construct, and the location of the defect.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
在使用诱导膜技术时，对于移植骨随时间的体积变化知之甚少。本研究通过诱导膜技术后连续计算机断层扫描（CT）研究评估移植骨的体积变化。
方法
接受诱导膜技术骨移植的临界骨缺损患者在术后进行系列 CT 扫描。术后即刻、6 个月和 12 个月获得评估骨移植体积的 CT 扫描。术后 6 个月和 12 个月确定骨移植体积的变化。分析患者的人口统计学特征、骨移植的位置和组成以及固定结构的类型。
结果
40 名患者符合纳入标准。27 例胫骨和 13 例股骨，平均缺损大小为 8.6cm（范围 2.5-20.6cm）。这些患者中，21 例接受松质骨和脱钙骨基质（DBM）混合的自体骨移植，19 例接受诱导膜形成后 17 周的单纯自体骨移植。前 6 个月，骨质总体吸收率为-9.9%。从 6 个月到 12 个月，总体骨移植体积增加了+1.6%。在整个 12 个月期间，平均移植骨体积吸收率为-8.3%。发现移植骨早期体积变化与移植物混合物中 DBM 的百分比之间存在相关性。晚期体积变化与缺损位置或固定类型之间也存在相关性。
结论
在使用诱导膜技术治疗临界骨缺损 1 年后，移植骨的吸收率平均为-8.3%。体积变化受移植物骨的特性、固定结构和缺损位置的影响。
证据水平
治疗性 IV 级。欲了解完整的证据水平描述，请参见作者说明。
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