Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Medicine (Baltimore). 2022 Jun 24;101(25):e29292. doi: 10.1097/MD.0000000000029292.
: The aim of this study was to evaluate the efficacy of induced membrane technique (IMT), and to analyze the relationships between patient factors and surgical parameters as well as their impacts on achieving bone union and complication rates.
: A comprehensive, computerized search of PubMed, Embase, and The Cochrane Library was conducted, and articles published from January 1, 1978 to February 1, 2021 were included. Clinical trials matching the following inclusion criteria were included: 1. published as a case series, case-controlled studies, or cohort study; 2. IMT was performed for more than 10 cases within the study. Univariate and multivariate logistic regression were performed with random intercepts to determine the association of specific predictor variables with nonunion rate, postoperative infection, the need for additional procedures, and time to union.
: Seventy eight trials were included in the study with a total of 3840 patients managed with IMT. Mean age was 38.6 (0.8–88) years, mean size of bone defects was 6.4 (0–25) cm primarily distributed in the tibia (n = 1814, 60.9%), and overall union rate was 87.6%. Multivariate analysis showed the odds of nonunion were significantly increased in patients with an interval between two stages from 8 to 12 weeks and ≥12 weeks. Patients with preoperative infection and addition of antibiotic to bone cement during IMT had significantly decreased odds of longer union time, but preoperative infection caused increased odds of additional surgery. External fixation throughout 2 stages had significantly increased odds of postoperative infection and additional surgery.
: We recommend that the timing of the second stage should be delayed until 6 to 8 weeks after the first stage. Bone cement with antibiotics can control the infection rate and shorten the healing time. Furthermore, there is no need to avoid using internal fixation due to possible concerns about causing postoperative infection.
本研究旨在评估诱导膜技术（IMT）的疗效，并分析患者因素与手术参数之间的关系及其对实现骨愈合和并发症发生率的影响。
对 PubMed、Embase 和 The Cochrane Library 进行了全面的计算机检索，并纳入了 1978 年 1 月 1 日至 2021 年 2 月 1 日发表的文章。纳入的临床试验符合以下纳入标准：1. 发表为病例系列、病例对照研究或队列研究；2. 研究中 IMT 治疗超过 10 例。采用随机截距进行单变量和多变量逻辑回归，以确定特定预测变量与非愈合率、术后感染、需要额外手术以及愈合时间的关系。
共纳入 78 项研究，共 3840 例患者接受 IMT 治疗。平均年龄为 38.6（0.8-88）岁，骨缺损平均大小为 6.4（0-25）cm，主要分布在胫骨（n=1814，60.9%），总体愈合率为 87.6%。多变量分析显示，两期之间间隔 8 至 12 周和≥12 周的患者发生非愈合的可能性显著增加。术前感染且 IMT 中向骨水泥中添加抗生素的患者愈合时间明显延长，但术前感染导致额外手术的可能性增加。两期均采用外固定的患者术后感染和额外手术的可能性显著增加。
我们建议第二期的时间应延迟到第一期后 6 至 8 周。含抗生素的骨水泥可控制感染率并缩短愈合时间。此外，由于可能担心引起术后感染，无需避免使用内固定。
