Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China.
Banan Hospital of Chongqing Medical University, Banan District, Longzhouwan Street No. 659, Chongqing City, 400038, People's Republic of China.
J Orthop Surg Res. 2023 Nov 9;18(1):853. doi: 10.1186/s13018-023-04296-1.
In this study, we aimed to compare the outcomes of the two-stage induced membrane technique (IMT) and one-stage autografting in the treatment of aseptic atrophic nonunion in lower limb long bones.
From January 2014 to January 2022, we reviewed all surgically treated long bone nonunion patients, including patients aged 18 years or older with atrophic nonunion, who were either treated with the two-stage induced membrane technique (IMT) or one-stage autografting. Outcome parameters interns of clinical, quality of life and healthcare burden were recorded and retrospectively analysed between the two treatment populations. The follow-up time was at least 1 year.
In total, 103 patients who met the criteria for aseptic atrophic nonunion were enrolled. Among them, 41 (39.8%) patients were treated with two-stage IMT, and 62 (60.2%) patients were treated with one-stage autologous bone grafting. The follow-up time was 12 to 68 months, with an average of 28.4 months. The bone healing rate was comparable in both groups (IMT: 92.7% vs. one-stage grafting: 91.9%, P = 0.089) at 12 months post-operation, and the bone healing Lane-Sandhu score was superior in the IMT group (mean: 8.68 vs. 7.81, P = 0.002). Meanwhile, the SF-12 scores of subjective physical component score (PCS) (mean: 21.36 vs. 49.64, P < 0.01) and mental health component score (MCS) (mean: 24.85 vs. 46.14, P < 0.01) significantly increased in the IMT group, as well as in the one-stage grafting group, and no statistically significant difference was found within groups. However, the total hospital stays (median: 8 days vs. 14 days, P < 0.01) and direct medical healthcare costs (median: ¥30,432 vs. ¥56,327, P < 0.05) were greater in the IMT group, while the complications (nonunion 8, infection 3, material failure 2, and donor site pain 6) were not significantly different between the two groups (17.1% vs. 19.4, P = 0.770).
The data indicate that two-stage method of IMT serves as an alternative method in treating atrophic nonunion; however, it may not be a preferred option, in comprehensive considering patient clinical outcomes and healthcare burden. More evidence-based research is needed to further guide clinical decision-making.
本研究旨在比较两阶段诱导膜技术（IMT）和一期自体植骨治疗下肢长骨无菌性萎缩性骨不连的疗效。
从 2014 年 1 月至 2022 年 1 月，我们回顾了所有接受手术治疗的长骨骨不连患者，包括年龄在 18 岁及以上、有萎缩性骨不连的患者，这些患者分别接受两阶段诱导膜技术（IMT）或一期自体植骨治疗。记录并回顾性分析了两组患者的临床、生活质量和医疗负担的结局参数。随访时间至少 1 年。
共有 103 例符合无菌性萎缩性骨不连标准的患者入选。其中，41 例（39.8%）患者接受两阶段 IMT 治疗，62 例（60.2%）患者接受一期自体骨移植治疗。随访时间为 12 至 68 个月，平均 28.4 个月。术后 12 个月，两组的骨愈合率相当（IMT：92.7%比一期植骨：91.9%，P=0.089），IMT 组的骨愈合 Lane-Sandhu 评分更高（平均：8.68 比 7.81，P=0.002）。同时，IMT 组的 SF-12 量表主观身体成分评分（PCS）（平均：21.36 比 49.64，P<0.01）和心理健康成分评分（MCS）（平均：24.85 比 46.14，P<0.01）显著升高，而一期植骨组也有显著升高，组内无统计学差异。然而，IMT 组的总住院时间（中位数：8 天比 14 天，P<0.01）和直接医疗保健费用（中位数：¥30432 比 ¥56327，P<0.05）较高，而两组的并发症（不愈合 8 例，感染 3 例，材料失败 2 例，供区疼痛 6 例）无显著差异（17.1%比 19.4%，P=0.770）。
数据表明，两阶段 IMT 方法是治疗萎缩性骨不连的一种替代方法；然而，综合考虑患者的临床结局和医疗负担，它可能不是首选方法。需要更多的基于证据的研究来进一步指导临床决策。
