Issaoui Hichem, Fekhaoui Mohammed Reda, Jamous Moheddin, Masquelet Alain-Charles
Department of Orthopedic Surgery and Trauma, Regional Hospital Center of Orleans, Orleans, France.
Department of Trauma and Orthopedic Surgery, Ibn Sina University Hospital, Faculty of Medicine, Mohammed V University of Rabat, Rabat, Morocco.
Case Rep Orthop. 2021 Mar 10;2021:8829158. doi: 10.1155/2021/8829158. eCollection 2021.
The induced membrane technique was initially described by Masquelet et al. in 1986 as a treatment for tibia nonunion; then, it became one of the established methods in the management of bone defects. Several changes have been made to this technique and have been used in different contexts and different methodologies. We present the case of a 16-year-old girl admitted to our department for a polytrauma after a motorcycle accident. She presented a Gustilo III-A open fracture of the right femoral shaft with a large bone defect of 8 centimeters that we treated with a modified Masquelet technique. In the first stage, an Open Reduction and Internal Fixation of the fracture was made using a 4,5 mm Dynamic Compression Plate and a PMMA cement was inserted at the bone defect area. The second stage was done after 11 weeks, and the defect area was filled exclusively with bone allograft from a bone bank. Complete bony union was seen at 60 weeks of follow-up. After the removal of the implants by another surgeon, the patient presented an atraumatic fracture of the neoformed bone that we treated with intramedullary femoral nailing associated with a local autograft using reaming debris. A complete bony union was achieved after 12 weeks with a complete range of motion of the hip and knee. The stability given to the fracture is essential because it influences the quality of the induced membrane and Masquelet has recommended high initial fixation rigidity to promote incorporation of the graft. It is recommended to delay the second stage of this technique after 8 weeks, especially in femoral reconstruction, to optimize the quality of the induced membrane. Several studies used a modified induced membrane technique to recreate a traumatic large bone defect, and all of them used an autologous bone graft alone or an enriched bone graft. In this case, the use of allograft exclusively seems to be as successful as an autologous or enriched bone graft. Now, with the advent of bone banks, it is possible to get an unlimited amount of allograft, so additional research and large studies are necessary before giving recommendations.
诱导膜技术最初由马斯克莱等人于1986年描述为治疗胫骨骨不连的方法；随后，它成为骨缺损治疗中既定的方法之一。该技术已发生了一些变化，并被应用于不同的情境和不同的方法中。我们报告一例16岁女孩，因摩托车事故导致多发伤后入住我科。她右侧股骨干出现Gustilo III - A型开放性骨折，伴有8厘米的大骨缺损，我们采用改良的马斯克莱技术进行治疗。第一阶段，使用4.5毫米动力加压钢板对骨折进行切开复位内固定，并在骨缺损区域植入聚甲基丙烯酸甲酯（PMMA）骨水泥。第二阶段在11周后进行，缺损区域仅用骨库的同种异体骨填充。随访60周时可见完全骨愈合。在另一位外科医生取出植入物后，患者新形成的骨出现了无创伤性骨折，我们采用股骨髓内钉固定并使用扩髓碎屑进行局部自体骨移植治疗。12周后实现了完全骨愈合，髋和膝关节活动范围完全恢复。给予骨折的稳定性至关重要，因为它会影响诱导膜的质量，马斯克莱建议采用高初始固定刚度以促进移植物的融合。建议在8周后延迟该技术的第二阶段，尤其是在股骨重建中，以优化诱导膜的质量。几项研究使用改良的诱导膜技术来重建创伤性大骨缺损，所有这些研究都单独使用自体骨移植或富化骨移植。在本病例中，仅使用同种异体骨似乎与自体或富化骨移植一样成功。现在，随着骨库的出现，可以获得无限量的同种异体骨，因此在给出建议之前还需要进行更多的研究和大型研究。
