Shen Jie, Wei Zhiyuan, Wang Shulin, Wang Xiaohua, Lin Wei, Liu Lei, Wang Guanglin
Trauma Medical Centre, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Bone Joint Res. 2023 Sep 12;12(9):546-558. doi: 10.1302/2046-3758.129.BJR-2022-0439.R2.
This study aimed to evaluate the effectiveness of the induced membrane technique for treating infected bone defects, and to explore the factors that might affect patient outcomes.
A comprehensive search was performed in PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases between 1 January 2000 and 31 October 2021. Studies with a minimum sample size of five patients with infected bone defects treated with the induced membrane technique were included. Factors associated with nonunion, infection recurrence, and additional procedures were identified using logistic regression analysis on individual patient data.
After the screening, 44 studies were included with 1,079 patients and 1,083 segments of infected bone defects treated with the induced membrane technique. The mean defect size was 6.8 cm (0.5 to 30). After the index second stage procedure, 85% (797/942) of segments achieved union, and 92% (999/1,083) of segments achieved final healing. The multivariate analysis with data from 296 patients suggested that older age was associated with higher nonunion risk. Patients with external fixation in the second stage had a significantly higher risk of developing nonunion, increasing the need for additional procedures. The autografts harvested from the femur reamer-irrigator-aspirator increased nonunion, infection recurrence, and additional procedure rates.
The induced membrane technique is an effective technique for treating infected bone defects. Internal fixation during the second stage might effectively promote bone healing and reduce additional procedures without increasing infection recurrence. Future studies should standardize individual patient data prospectively to facilitate research on the affected patient outcomes.
本研究旨在评估诱导膜技术治疗感染性骨缺损的有效性，并探讨可能影响患者预后的因素。
于2000年1月1日至2021年10月31日期间，在PubMed、Embase和Cochrane对照试验中央注册库数据库中进行全面检索。纳入至少有5例采用诱导膜技术治疗感染性骨缺损患者的研究。使用个体患者数据的逻辑回归分析确定与骨不连、感染复发和额外手术相关的因素。
筛选后，纳入44项研究，共1079例患者、1083段采用诱导膜技术治疗的感染性骨缺损。平均缺损大小为6.8cm（0.5至30）。在首次二期手术后，85%（797/942）的骨段实现骨愈合，92%（999/1083）的骨段实现最终愈合。对296例患者数据的多变量分析表明，年龄较大与骨不连风险较高相关。二期采用外固定的患者发生骨不连的风险显著更高，增加了额外手术的需求。从股骨扩髓-冲洗-吸引器获取的自体骨增加了骨不连、感染复发和额外手术率。
诱导膜技术是治疗感染性骨缺损的有效技术。二期内固定可能有效促进骨愈合并减少额外手术，且不增加感染复发率。未来研究应前瞻性地规范个体患者数据，以促进对受影响患者预后的研究。
