Department of Orthopaedic, Trauma and Reconstructive Surgery, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140 Clamart, France; Laboratory of Bioengineering and Biomechanics for Bone Articulation (B2OA - UMR CNRS 7052), Paris-Diderot University, 10 avenue de Verdun, 75010 Paris, France.
Department of Orthopaedic, Trauma and Reconstructive Surgery, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140 Clamart, France.
Injury. 2022 Oct;53 Suppl 2:S13-S19. doi: 10.1016/j.injury.2022.07.027. Epub 2022 Jul 17.
The induced membrane technique has been developed to address bone defect of critical size from various origins. Despite its exceptional efficacy, several cases underwent a failure, which is regularly associated with a septic problem. The best way to conduct in this situation remains debated.
To estimate use of bioactive glass S53P4 (BAG-53P4) in induced membrane technique failures or with an anticipated high risk of failure.
We conducted a retrospective analysis of patients from several medical centers in Europe where BAG-S53P4 has been used inside an induced membrane. The etiology of the defect, the bone fixation used, the delay the bioactive glass was placed, the reason why the bioactive glass was used and the results were reported.
Eight cases were included (3 women and 5 men). Mean age was 43 years (16-82; Standard deviation 23). Mean height was 171 cm (162-184; SD 7), mean weight was 69 kg (60-85; SD 8) and Body Mass Index was 23,39 M/Kg2 (21,9-25,1; SD 1,22). Mean length of defect was 68 mm (40-100mm, SD 23). All patients received BAG-S53P4 granules (BonAlive Biomaterials Ltd, Turku, Finland) to fill the resultant cavity (3 as a stand-alone in the induced membrane and 5 mixed with autograft). Three patients were implanted with BAG-S53P4 during the second stage of a first induced membrane technique because of a high risk of infection (three open fractures); two patients were implanted with BAG-S53P4 during the second stage of a first induced membrane technique because of the great size of the defect (two infectious non-union); two patients were implanted with BAG-S53P4 as a third stage of induced membrane technique, i.e. inside a previously grafted membrane, because of a recurrence of the infection; and one patient was implanted with BAG-S53P4 during the second stage of a second induced membrane technique to avoid a new failure. At a follow-up of 16 months, all healed without any recurrence of the infection.
Critical size bone defects caused by an open fracture or an active infection can usually be addressed by the induced membrane technique. However, some cases are at high risk of failure because of the occurrence or recurrence of an infection. In these cases, bioactive glass may help the surgeon to improve the rate of bone union.
BAG-S53P4 may be considered as bone graft in an induced membrane technique, especially when there is a high probability of occurrence or recurrence of a bone infection.
诱导膜技术已经被开发出来，以解决来自不同来源的临界大小的骨缺损。尽管它具有极好的疗效，但仍有几例出现了失败，这通常与感染问题有关。在这种情况下，最好的处理方法仍存在争议。
评估生物活性玻璃 S53P4（BAG-53P4）在诱导膜技术失败或预期失败风险高的情况下的应用。
我们对欧洲几家医疗中心使用诱导膜内 BAG-S53P4 的患者进行了回顾性分析。报告了缺陷的病因、使用的骨固定物、生物活性玻璃放置的延迟时间、使用生物活性玻璃的原因和结果。
共纳入 8 例患者（3 名女性，5 名男性）。平均年龄为 43 岁（16-82 岁；标准差 23）。平均身高为 171cm（162-184cm；标准差 7cm），平均体重为 69kg（60-85kg；标准差 8kg），体重指数为 23.39M/Kg2（21.9-25.1；标准差 1.22）。平均缺陷长度为 68mm（40-100mm，标准差 23mm）。所有患者均接受 BAG-S53P4 颗粒（BonAlive Biomaterials Ltd，图尔库，芬兰）填充所得空腔（3 例作为诱导膜内的独立填充物，5 例与自体移植物混合）。3 例因感染风险高（3 例开放性骨折）在第一诱导膜技术的第二阶段植入 BAG-S53P4；2 例因缺陷较大（2 例感染性骨不连）在第一诱导膜技术的第二阶段植入 BAG-S53P4；2 例因感染复发在先前植骨膜内第三阶段植入 BAG-S53P4；1 例因第二诱导膜技术的第二阶段植入 BAG-S53P4 以避免新的失败。随访 16 个月后，所有患者均愈合，无感染复发。
由开放性骨折或活动性感染引起的临界大小骨缺损通常可通过诱导膜技术解决。然而，一些病例由于感染的发生或复发，存在较高的失败风险。在这些情况下，生物活性玻璃可能有助于外科医生提高骨愈合率。
BAG-S53P4 可被视为诱导膜技术中的骨移植物，特别是在发生或复发骨感染的可能性较高时。
