Surgical errors and complications due to induced membrane technique: an analysis of 44 cases of infected bone defects

doi:10.3969/j.issn.2095-4344.0915

Abstract

Abstract:

BACKGROUND: There is a high incidence of complications in the treatment of infected bone defects by wrapped bone grafting using induced membrane.

OBJECTIVE: To investigate how to reduce the surgical errors and complications of induced membrane technique.

METHODS: Clinical data from 44 patients with infected bone defect treated with induced membrane technique were retrospectively analyzed. There were 29 males and 15 females, aged 14-69 years old. All patients were followed up for 15-51 months postoperatively. Forming way and quality of bone cement spacer, quality of induced membrane formed, concentration of antibiotics loaded, healing of incision and bony defect, complication and mobility of adjacent joints were observed.

RESULTS AND CONCLUSION: (1) Bone cement spacer formed in vivo in 23 cases and in vitro in 21 cases. The quality of spacer formed was excellent in 14 cases, good in 17 cases, and poor in 13 cases. The induced membrane was of integrity in 22 cases, had small defects in 13 cases and had large defects in 9 cases. Concentration of vancomycin was low in 19 cases and moderate in 25 cases. Defects in the induced membrane were caused by small size of induced membrane formed which could not completely wrap the graft material in 13 cases and by the difficult removal due to the tight connection between the spacer and the broken end in 9 cases. (2) The clinical healing time was 3-16 months with an average of 5.9 months. The average frequency of operations using induced membrane technique until bone healing was 2.4 times. (3) There were 11 cases of complications, of which 8 cases were noted at 2 years prior to the use of induced membrane technique, 3 cases in the first stage (1 of incision disruption and superficial infection, 1 of deep infection, and 1 of flap necrosis, and 8 cases in the second stage (2 of nonunion, 5 of recurrence of infection, and 1 of malunion). (4) The range of movement of adjacent joints at the last follow-up was excellent in 24 cases, good in 11 cases, fair in 7 cases and poor in 2 cases, with the excellent and good rate of 80%. These findings indicate that the induced membrane technique is an effective method for infected bone defects. However, the presence of a learning curve is prone to cause surgical errors. Surgeons should master the surgical skills, especially the skills of spacer making, so as to avoid surgical errors, reduce complications and improve the effectiveness of treatment.

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

Key words: Bone Transplantation, Postoperative Complications, Tissue Engineering

CLC Number:

R318

Zhou Zi-hong, Feng De-hong, Xu Ke-lin, Yin Qu-dong. Surgical errors and complications due to induced membrane technique: an analysis of 44 cases of infected bone defects[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(26): 4162-4167.

Figures/Tables 4

2.3 治疗结果分析填塞物体内成型23例，体外成型21例；填塞物制作质量优14例，良17例，差13例。诱导膜完整22例，少许缺损13例，较多缺损9例。万古霉素浓度低度19例，中度25例。导致诱导膜缺损者为骨水泥填塞物制作质量为差，形成的诱导膜腔过无法包裹植骨材料(13例)和填塞物体内成型致填塞物与断端连接过紧取出困难需要用暴力咬除致诱导膜损伤性缺损(9例)。2例骨不愈合，再次植骨后骨愈合；患者临床愈合时间3-16个月，平均5.9个月。 44例中共11例发生并发症(发生率为25%)，包括骨不愈合2例，感染复发7例，皮瓣坏死和畸形愈合各1例。其中，8例(占72%)是发生在诱导膜技术应用前2年。第一阶段术后并发症3例(占27%)，包括1例皮瓣缝合张力过大，切口逐渐裂开、骨水泥外露污染，诊断为表浅感染，需要更换骨水泥和皮瓣修复伤口才愈合；1例为术后皮瓣部分坏死，但无骨水泥和骨外露，再次扩创和游离植皮后伤口才愈合；1例为深部感染，该患者的万古霉素浓度为较低度者，需要扩创、骨水泥填塞和局部皮瓣转移修复后伤口才愈合。第二阶段术后并发症8例(占72%)，包括2例骨缺损断端连接处骨不愈合，该2例骨水泥填塞物制作质量均为差，而且填塞物为体内成型，见图3；5例为术后感染复发，均有局部红肿热痛等感染迹象，其中3例保守治疗无效，出现破溃和流脓，诊断为深部感染，再次行万古霉素骨水泥填塞后控制骨感染，该3例填塞物制作质量为差、诱导膜较多缺损和万古霉素浓度为低度者，见图4，另2例保守治疗后控制感染，诊断为表浅感染，该2例患者为诱导膜完整和较少缺损者各1例，万古霉素浓度均为中度和低度各1例；1例畸形愈合，经Ilizarove技术治疗矫正后恢复正常。末次随访，无骨愈合后再骨折和内固定断裂，临近关节活动度恢复优24例、良11例、可7例、差2例(优良率80%)。患者自应用诱导膜技术治疗至骨愈合，手术次数2-4次，平均2.4次。并发症情况见表1。"

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