Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri, USA.
J Orthop Res. 2021 Apr;39(4):707-718. doi: 10.1002/jor.24978. Epub 2021 Jan 13.
Masquelet's induced membrane technique (MIMT) is a relatively new, two-stage surgical procedure to reconstruct segmental bone defects. First performed by Dr. Masquelet in the mid-1980s, MIMT has shown great promise to revolutionize critical-sized bone defect repair and has several advantages over its alternative, distraction osteogenesis (DO). Also, its success in extremely challenging cases (defects > 15 cm) suggests that its study could lead to discovery of novel biological mechanisms that might be at play during segmental defect healing and fracture non-union. MIMT's advantages over DO have led to a world-wide increase in MIMT procedures over the past decades. However, MIMT often needs to be repeated and so the average initial success rate in adults lags significantly behind that of DO (86% vs 95%, respectively). The autologous foreign-body membrane created during the first stage by the immune system's response to a polymethyl methacrylate bone cement spacer is critical to supporting the morselized bone graft implanted in the second stage. However, the biological and/or physical mechanisms by which the membrane supports graft to bone union are unclear. This lack of knowledge makes refining MIMT and improving the success rates through technique improvements and patient selection a significant challenge and hinders wider adoption. In this review, current knowledge from basic, translational, and clinical studies is summarized. The dynamics of both stages under normal conditions as well as with drug or material perturbations is discussed along with perspectives on high-priority future research directions.
Masquelet 诱导膜技术（MIMT）是一种相对较新的两阶段手术方法，用于重建节段性骨缺损。该技术由 Masquelet 博士于 20 世纪 80 年代中期首次提出，有望彻底改变临界尺寸骨缺损修复，并具有优于其他替代方法——牵张成骨术（DO）的几个优势。此外，它在极具挑战性的病例（缺损>15cm）中的成功表明，对其进行研究可能会发现新的生物学机制，这些机制可能在节段性缺损愈合和骨折不愈合过程中发挥作用。MIMT 优于 DO 的优势导致过去几十年来全球 MIMT 手术数量增加。然而，MIMT 通常需要重复进行，因此成年人的平均初始成功率明显低于 DO（分别为 86%和 95%）。免疫系统对聚甲基丙烯酸甲酯骨水泥间隔物的反应在第一阶段产生的自体异物膜对于支持在第二阶段植入的碎骨移植物至关重要。然而，膜支持移植物与骨愈合的生物学和/或物理机制尚不清楚。这种知识的缺乏使得细化 MIMT 并通过技术改进和患者选择提高成功率成为一个重大挑战，并阻碍了更广泛的应用。在这篇综述中，总结了来自基础、转化和临床研究的现有知识。讨论了正常情况下以及药物或材料干扰下两个阶段的动力学，并提出了高优先级的未来研究方向的观点。
