Department of traumatology, UMC Ljubljana, Slovenia.
Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste (Italy).
Acta Biomed. 2020 Dec 30;91(14-S):e2020012. doi: 10.23750/abm.v91i14-S.10890.
Optimal treatment for acute post-traumatic bone loss in the tibia remains unclear. Distraction osteogenesis (DO) and induced membrane technique (IM) have been established as the mainstays of treatment. Aim of this article is to review the current evidence regarding the use of these two methods.
A review of the MEDLINE database was performed with strict inclusion and exclusion criteria focusing on treatment of the acute bone loss after open tibia fractures with DO and IM. Bone union rate was taken as the primary outcome and infection rate as secondary outcome.
Four studies out of 78 on the use of the DO and three studies out of 18 on the use of the IM technique matched the inclusion criteria. Union rate in the DO group ranged between 92% and 100%, with infection rates between 0 and 4%. In the IM group, union was reached in 42% to 100% of cases, with septic complications occurring in 12% to 43%. Differences in union rate and infection rate reached statistical significance.
We found a considerable evidence gap regarding treatment of bone loss in high grade open tibia fractures. The limitations of our study prevented us from drawing clear causative conclusions on the results. Although our study points to higher union rates and lower infection rate with the use of the DO technique, the results remain preliminary and further high-level evidence is needed to establish the roles of DO and IM in treatment of acute bone loss in open tibia fractures.
急性创伤后胫骨骨丢失的最佳治疗方法仍不明确。牵张成骨术（DO）和诱导膜技术（IM）已被确立为主要的治疗方法。本文旨在回顾这两种方法的应用现状。
通过严格的纳入和排除标准，对 MEDLINE 数据库进行了回顾，重点关注使用 DO 和 IM 治疗开放性胫骨骨折后的急性骨丢失。将骨愈合率作为主要结局，感染率作为次要结局。
在 78 项关于 DO 使用的研究中有 4 项，在 18 项关于 IM 技术使用的研究中有 3 项符合纳入标准。DO 组的愈合率在 92%至 100%之间，感染率在 0%至 4%之间。在 IM 组中，愈合率在 42%至 100%之间，有 12%至 43%的患者出现感染并发症。愈合率和感染率的差异具有统计学意义。
我们发现，对于高等级开放性胫骨骨折骨丢失的治疗，存在相当大的证据差距。我们研究的局限性使我们无法对结果做出明确的因果结论。尽管我们的研究表明，使用 DO 技术可以提高愈合率，降低感染率，但结果仍初步的，需要进一步的高级别证据来确定 DO 和 IM 在治疗开放性胫骨骨折急性骨丢失中的作用。
