Steffenson Lillia, Roszman Alex, Wallace Cameron, Kot Taylor Corbin, Wallace Stephen, Spitler Clay, Bergin Patrick, Githens Michael, Haller Justin
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah.
Department of Orthopaedic Surgery, University of Alabama Birmingham, Birmingham, Alabama.
J Orthop Trauma. 2023 May 1;37(5):e194-e199. doi: 10.1097/BOT.0000000000002548.
To compare outcomes of Masquelet-induced membrane technique (IMT) in metaphyseal and diaphyseal fractures with acute bone loss.
Retrospective cohort study.
Four Level 1 Academic Trauma Centers.
PATIENTS/PARTICIPANTS: Patients acutely treated with IMT for traumatic lower extremity bone loss at 4 Level 1 trauma centers between 2010 and 2020.
Operative treatment with placement of cement spacer within 3 weeks of initial injury followed by staged removal and bone grafting to the defect.
Fracture union, infection, revision grafting, time to union, and amputation.
One hundred twenty fractures met inclusion criteria, including 43 diaphyseal fractures (DIM) and 77 metaphyseal fractures (MIM). Demographic characteristics were not significantly different, except for age (DIM 34 years vs. MIM 43 years, P < 0.001). Union after treatment with IMT was 89.2% overall. After controlling for age, this was not significantly different between DIM (41/43, 95.3%) and MIM (66/77, 85.7%) ( P = 0.13) nor was the rate of infection between groups. There was no difference in any secondary outcomes.
The overall union rate in the current series of acute lower extremity fractures treated with the induced membrane technique was 89%. There was no difference in successful union between patients with diaphyseal bone loss or metaphyseal bone loss treated with IMT. Similarly, there was no difference in patients with tibial or femoral bone loss treated with induced membrane. Defect size after debridement may be more prognostic for secondary operations rather than the limb segment involved or the degree of soft-tissue injury.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较Masquelet诱导膜技术（IMT）治疗伴有急性骨缺损的干骺端骨折和骨干骨折的疗效。
回顾性队列研究。
四个一级学术创伤中心。
患者/参与者：2010年至2020年间在4个一级创伤中心接受IMT急性治疗创伤性下肢骨缺损的患者。
在初次受伤后3周内植入骨水泥间隔物进行手术治疗，随后分期取出并对骨缺损处进行植骨。
骨折愈合、感染、翻修植骨、愈合时间和截肢。
120例骨折符合纳入标准，其中包括43例骨干骨折（DIM）和77例干骺端骨折（MIM）。除年龄外（DIM为34岁，MIM为43岁，P<0.001），人口统计学特征无显著差异。IMT治疗后的总体愈合率为89.2%。在控制年龄后，DIM（41/43，95.3%）和MIM（66/77，85.7%）之间的愈合率无显著差异（P=0.13），两组间的感染率也无差异。任何次要结局均无差异。
在当前采用诱导膜技术治疗的急性下肢骨折系列中，总体愈合率为89%。IMT治疗的骨干骨缺损或干骺端骨缺损患者之间的成功愈合率无差异。同样，诱导膜治疗的胫骨或股骨骨缺损患者之间也无差异。清创后的缺损大小对二次手术的预后影响可能更大，而非所涉及的肢体节段或软组织损伤程度。
预后III级。有关证据级别的完整描述，请参阅作者指南。
