中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (10): 1634-1640.doi: 10.12307/2024.365

• 生物材料综述 biomaterial review • 上一篇    

生物材料在Masquelet技术中的应用

韩凤平1,李怀任1,常文利2,田宝方2,冯  立2   

  1. 1济宁医学院,山东省济宁市  272000;2济宁市第一人民医院,山东省济宁市  272000
  • 收稿日期:2023-04-12 接受日期:2023-05-26 出版日期:2024-04-08 发布日期:2023-08-21
  • 通讯作者: 冯立,博士,副主任医师,济宁市第一人民医院,山东省济宁市 272000
  • 作者简介:韩凤平,男,1997年生,山东省聊城市人,汉族,济宁医学院在读硕士,主要从事骨创伤及骨缺损修复研究。
  • 基金资助:
    济宁市重点研发计划项目(2021YXNS125),项目负责人:冯立;济宁市第一人民医院博士基金(2022-BS-005),项目负责人:冯立

Application of biomaterials in Masquelet technology

Han Fengping1, Li Huairen1, Chang Wenli2, Tian Baofang2, Feng Li2   

  1. 1Jining Medical University, Jining 272000, Shandong Province, China; 2Jining No.1 People’s Hospital, Jining 272000, Shandong Province, China
  • Received:2023-04-12 Accepted:2023-05-26 Online:2024-04-08 Published:2023-08-21
  • Contact: Feng Li, MD, Associate chief physician, Jining No.1 People’s Hospital, Jining 272000, Shandong Province, China
  • About author:Han Fengping, Master candidate, Jining Medical University, Jining 272000, Shandong Province, China
  • Supported by:
    Masquelet technique| induced membrane technique| induced membrane| biomaterial| bone regeneration| bone defect| bone healing| nonunion bone| bone fracture

摘要:


文题释义:

Masquelet技术即Masquelet诱导膜技术,是一种简单有效地修复节段性骨缺损的技术,该技术可分为两阶段手术:第一阶段,在缺损处彻底清创后使用聚甲基丙烯酸甲酯骨水泥填充于骨缺损部位,然后固定缺损部位,6-8 周后聚甲基丙烯酸甲酯骨水泥间隔物将被形成的诱导膜所包绕;第二阶段,切开诱导膜,在保持诱导膜相对完整的情况下取出骨水泥,并在诱导膜内植入自体颗粒状松质骨后固定、缝合。
生物材料:是用于与生命系统接触和发生相互作用的,并能对其细胞、组织和器官进行诊断治疗、替换修复或诱导再生的一类天然或人工合成的特殊功能材料,又称生物医用材料。


背景:骨缺损的修复和治疗难度较高,其临床治疗方案多样,Masquelet技术是一种成功率高、疗效可靠且已经应用于临床的治疗方法,但是该技术目前机制并未完全明确,且该技术在临床应用上还存在一些问题,技术仍然不是特别成熟。

目的:对现阶段在Masquelet技术改进的研究中所应用的生物材料进行整理与归纳,为该技术的进一步发展提供思路与参考。
方法:通过计算机在中国知网和PubMed数据库中检索2013年1月至2022年11月的相关文献,中文检索词为“Masquelet技术,膜诱导技术,诱导膜,生物材料,骨缺损”;英文检索词为“Masquelet technique,Induced membrane technique,Induced membrane,biomaterial,Bone defect”,对最终纳入符合标准的58篇文献进行综述。

结果与结论:①Masquelet技术的出现与不断发展为治疗骨缺损提供了一种治疗策略,有些研究者将研究方向放在研究出更好的间隔材料、自体骨的替代材料和与诱导膜具有相同性能的膜材料上,以便于将两阶段术式简化,缩短治疗时间和减轻患者的痛苦。②硫酸钙、硅胶、聚乳酸-羟基乙酸共聚物和聚丙烯在动物实验或者临床应用中可以替代聚甲基丙烯酸甲酯骨水泥形成诱导膜,且各有优势,但是与预想不同,常见的钛和聚乙烯醇海绵反而不能在这一步中作为聚甲基丙烯酸甲酯骨水泥的替代材料。③自体骨的替代材料多种多样,同种异体骨、β-磷酸三钙、可吸收性明胶海绵、α-硫酸钙半水合物、生物活性玻璃、钛和钽等材料都在临床或基础实验中证明了其可以在术式第二阶段中减少自体松质骨植骨量的能力,其中同种异体骨、β-磷酸三钙、生物活性玻璃、钛和钽等材料可替代自体骨作为移植物,其余材料需与自体骨混合使用。④仿生诱导膜、人羊膜、人脱细胞真皮、聚四氟乙烯甚至自体皮质骨通过实验证实了其与诱导膜具有相似性能。⑤现阶段,众多生物材料在该技术中的应用与研究大多数仍存在于基础研究阶段,尚未应用于临床实践或大范围推广,但是上述材料可为Masquelet技术机制的探究、术式的改进与临床应用提供更充分的理论依据和新思路。

https://orcid.org/0009-0005-6019-6257(韩凤平);https://orcid.org/0009-0008-8651-0234(冯立)

中国组织工程研究杂志出版内容重点:生物材料;骨生物材料口腔生物材料纳米材料缓释材料材料相容性组织工程

关键词: Masquelet技术, 膜诱导技术, 诱导膜, 生物材料, 骨再生, 骨缺损, 骨愈合, 骨不愈合, 骨折

Abstract: BACKGROUND: The remediation and treatment of bone defects present considerable challenges, with a variety of clinical intervention strategies available. One such approach, the Masquelet technique, has demonstrated high rates of success and reliable outcomes and is currently employed in clinical practice. However, the underlying mechanisms of this technique remain incompletely understood, and certain challenges persist in its clinical application, indicating that this technique is not yet fully mature. 
OBJECTIVE: To compile and categorize the biomaterials currently employed in research aimed at improving the Masquelet technique, in order to provide insights and references for the further development of this technique.
METHODS: A literature search of the China National Knowledge Infrastructure and PubMed databases was conducted, spanning publications from January 2013 to November 2022. The search terms used included “Masquelet technique; induced membrane technique; induced membrane; biomaterial; bone defect” in both Chinese and English. A total of 58 articles meeting the inclusion criteria were reviewed.
RESULTS AND CONCLUSION: (1) The emergence and continual development of the Masquelet technique provide a therapeutic strategy for treating bone defects. Some researchers are focusing on developing superior spacer materials, autograft substitutes, and membrane materials that mimic the properties of the induced membrane, to simplify the two-stage procedure, shorten treatment duration, and reduce patient distress. (2) Calcium sulfate, silicone, poly(lactic-co-glycolic acid), and polypropylene can replace polymethylmethacrylate bone cement to form induced membranes in animal experiments or clinical applications, each with their advantages. Contrary to expectations, common materials such as titanium and polyvinyl alcohol sponge cannot replace polymethylmethacrylate bone cement. (3) Autograft substitutes are diverse, with allograft bone, β-tricalcium phosphate, absorbable gelatin sponge, α-calcium sulfate hemihydrate, bioactive glass, titanium, and tantalum demonstrating their ability to reduce the quantity of autologous cancellous bone graft required in the second stage of the procedure. Among them, allograft bone, β-tricalcium phosphate, bioactive glass, titanium and tantalum can replace autogenous bone as grafts, and other materials need to be mixed with autogenous bone, in both clinical and fundamental experiments. (4) Biomimetic-induced membranes, human amnion, human decellularized dermis, polytetrafluoroethylene, and even autogenous cortical bone have been shown to possess properties similar to the induced membrane. (5) Most of the application and research of biomaterials in this technology still exist in the stage of basic research and have not been applied in clinical practice or popularized on a large scale, but the above materials can provide more sufficient theoretical basis and new ideas for the exploration of Masquelet technical mechanism, the improvement of surgical methods and clinical application.

Key words: Masquelet technique, induced membrane technique, induced membrane, biomaterial, bone regeneration, bone defect, bone healing, nonunion bone, bone fracture" id="__kindeditor_bookmark_start_131__">

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