Kołodziejczyk Kamil, Ropielewski Aleksander, Garlewicz Rafał, Złotorowicz Marcin, Czubak Jarosław
Department of Replantation and Reconstruction, Centre of Postgraduate Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland.
Medicina (Kaunas). 2024 Nov 24;60(12):1933. doi: 10.3390/medicina60121933.
Successful treatment of severe trauma and fractures of the long bones with successful healing and bone union is still a significant challenge for surgeons. Unfortunately, up to 10% of long-bone fractures develop bone healing disorders. The aim of this study was to evaluate the results of treating bone defects with different etiologies in the upper and lower extremities using the induced membrane technique. We prospectively evaluated the radiological and clinical outcomes of 45 patients with severe bone defects treated with the induced membrane technique during the period from May 2021 to October 2023. The time to bone defect regeneration, size of the bone defect, and the cost of treatment were evaluated. Functional outcomes were assessed using the Disabilities of the Arm Shoulder and Hand (DASH) scale, SF-36, and the Lower Limb Functional Index (LLFI). The mean follow-up time was 31 months (12-35). There were 20 patients with upper extremity bone defects and 25 with lower extremity bone defects. The mean defect length was 7.9 cm for the upper extremity (3.5-18) and 5.3 cm for the lower extremity (3-11). The mean times to achieve bone union and remodeling were 6.0 months (3-12) and 9 months (3-13) for the upper and lower limbs, respectively. Clinical evaluation at the end of treatment (achieving bone union) showed statistically significant improvements in the DASH, SF-36, and LLFI scales for pre- and postoperative outcomes. There was no statistical significance in the SF-36 clinical scale scores after surgical treatment compared to reconstructive treatment of upper and lower extremity bone defects. The presented reconstructive approach to the treatment of bone defects and healing disorders and extensive analysis demonstrate the effectiveness of the induced membrane technique in a short follow-up period, with a relatively high level of patient comfort and good clinical results in the treatment of severe bone defects with particularly infectious etiologies.
成功治疗严重创伤和长骨骨折并实现愈合和骨愈合，对外科医生来说仍然是一项重大挑战。不幸的是，高达10%的长骨骨折会出现骨愈合障碍。本研究的目的是评估采用诱导膜技术治疗上下肢不同病因骨缺损的效果。我们前瞻性地评估了2021年5月至2023年10月期间采用诱导膜技术治疗的45例严重骨缺损患者的影像学和临床结果。评估了骨缺损再生时间、骨缺损大小和治疗费用。使用手臂、肩部和手部功能障碍（DASH）量表、SF-36和下肢功能指数（LLFI）评估功能结果。平均随访时间为31个月（12 - 35个月）。上肢骨缺损患者20例，下肢骨缺损患者25例。上肢平均缺损长度为7.9厘米（3.5 - 18厘米），下肢为5.3厘米（3 - 11厘米）。上肢和下肢实现骨愈合和重塑的平均时间分别为6.0个月（3 - 12个月）和9个月（3 - 13个月）。治疗结束时（实现骨愈合）的临床评估显示，术前和术后结果在DASH、SF-36和LLFI量表上有统计学显著改善。与上下肢骨缺损的重建治疗相比，手术治疗后SF-36临床量表评分无统计学意义。所提出的治疗骨缺损和愈合障碍的重建方法及广泛分析表明，诱导膜技术在短随访期内有效，在治疗具有特殊感染病因的严重骨缺损时患者舒适度相对较高且临床效果良好。
