Borzunov Dmitry Y, Kolchin Sergey N, Mokhovikov Denis S, Malkova Tatiana A
Department of Taumatology and Orthopedics, Ural State Medical University, Ekaterinburg 620109, Russia.
Orthopaedic Department 4, Ilizarov National Medical Research Center for Traumatology and Orthopaedics, Kurgan 640014, Russia.
World J Orthop. 2022 Mar 18;13(3):278-288. doi: 10.5312/wjo.v13.i3.278.
The Ilizarov bone transport (IBT) and the Masquelet induced membrane technique (IMT) have specific merits and shortcomings, but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies, including congenital deficiencies. Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments.
To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis, and present preliminary results of this technological solution.
Seven adults with post-traumatic tibial defects (subgroup A) and nine children (subgroup B) with congenital pseudarthrosis of the tibia (CPT) were treated with the combination of IMT and IBT after the failure of previous treatments. The mean number of previous surgeries was 2.0 ± 0.2 in subgroup A and 3.3 ± 0.7 in subgroup B. Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal. Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane, its compression and docking for consolidation without grafting. The outcomes were retrospectively studied after a mean follow-up of 20.8 ± 2.7 mo in subgroup A and 25.3 ± 2.3 mo in subgroup B.
The "true defect" after resection was 13.3 ± 1.7% in subgroup A and 31.0 ± 3.0% in subgroup B relative to the contralateral limb. Upon completion of treatment, defects were filled by 75.4 ± 10.6% and 34.6 ± 4.2%, respectively. Total duration of external fixation was 397 ± 9.2 and 270.1 ± 16.3 d, including spacer retention time of 42.4 ± 4.5 and 55.8 ± 6.6 d, in subgroups A and B, respectively. Bone infection was not observed. Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups. Ischemic regeneration was observed in two cases of subgroup B. Complications were corrected during the course of treatment. Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B. One non-united CPT case was further treated with the Ilizarov compression method only and achieved union. After a follow-up period of two to three years, refractures occurred in four cases of united CPT.
The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention. Refractures may occur in severe CPT.
伊里扎洛夫骨搬运术（IBT）和Masquelet诱导膜技术（IMT）各有优缺点，但大量研究表明，它们在治疗各种病因引起的广泛性长骨缺损（包括先天性缺损）方面具有疗效。将它们的显著优势相结合，似乎是一种有前景的策略，可增强骨再生，并降低创伤后和先天性缺损以及对其他治疗无反应的骨不连治疗中骨折的风险。
联合应用IBT和IMT治疗严重胫骨缺损和假关节，并展示该技术方案的初步结果。
7例创伤后胫骨缺损的成人患者（A组）和9例先天性胫骨假关节（CPT）患儿（B组），在先前治疗失败后接受IMT和IBT联合治疗。A组既往手术的平均次数为2.0±0.2次，B组为3.3±0.7次。第一步包括放置伊里扎洛夫框架并在缺损处植入间隔物以生成诱导膜，间隔物取出后诱导膜留在骨折间隙内。第二步是截骨并通过诱导膜内的隧道进行骨块搬运，对其进行加压和对接以实现愈合，无需植骨。对A组平均随访20.8±2.7个月、B组平均随访25.3±2.3个月后对结果进行回顾性研究。
相对于对侧肢体，切除后的“真正缺损”在A组为13.3±1.7%，在B组为31.0±3.0%。治疗完成时，缺损分别被填充了75.4±10.6%和34.6±4.2%。A组和B组外固定的总时长分别为397±9.2天和270.1±16.3天，其中间隔物留置时间分别为42.4±4.5天和55.8±6.6天。未观察到骨感染。两组术后并发症均为几例针道感染和再生畸形。B组有2例出现缺血性再生。并发症在治疗过程中得到纠正。A组所有患者和B组7例患者实现了骨愈合。1例CPT骨不连患者仅进一步采用伊里扎洛夫加压法治疗并实现了愈合。随访两到三年后，4例已愈合的CPT发生了骨折。
IMT和IBT联合应用在先前治疗失败的创伤后胫骨缺损中取得了良好效果，但由于间隔物留置，外固定时间较长。严重CPT可能会发生骨折。
