Bone healing effects of early-stage versus late-stage bone grafting within induced membrane

doi:10.3969/j.issn.2095-4344.1963

Abstract

Abstract:

BACKGROUND: It remains unclear regarding the difference in bone healing effects after early-stage versus late-stage bone grafting within induced membrane.

OBJECTIVE: To investigate the difference in bone healing effects of bone grafting within induced membrane in the repair of bone defects and the major factors that affect bone healing.

METHODS: Sixty-three patients with tibial bone defect who received treatment with induced membrane technique during January 2007 to August 2017 in Wuxi People’s Hospital and Wuxi Orthopedics Hospital, China. These patients consisted of 38 males and 25 females and were aged 16-69 years. According to the time of bone grafting within induced membrane after bone cement filling, these patients were divided into an early stage group (n=25, bone grafting in the induced membrane 6-8 weeks after filling bone cement) and a late stage group (n=38, bone grafting in the induced membrane 10-12 weeks after filling bone cement). The healing of bone defect and functional recovery of affected limbs were evaluated. The causes of delayed healing and nonunion were analyzed. This study was approved by the Medical Ethics Committee of Wuxi People’s Hospital and Wuxi Orthopedics Hospital, China (approval No. LW2019001).

RESULTS AND CONCLUSION: Bone graft was successfully completed in 63 patients. The induced membrane formed in the early stage group was thin and there were relatively more capillaries, while the induced membrane formed in the late stage group was usually thick and there were relatively few capillaries. All 63 patients were followed up for 16-50 months. In the early stage group, the wound or incision healed at first intention in 22 patients and delayed healing was observed in 3 patients. In the late stage group, the wound or incision healed at first intention in 34 patients, delayed healing was observed in 2 patients, and healing by the second intention was observed in 2 patients. In the early stage group, there was 1 patient developing delayed healing, no nonunion was observed, the clinical healing time was averaged 6.64 (range 5.0-12.0 months) months. In the late stage group, delayed healing occurred in 2 patients and nonunion was observed in 1 patient. The clinical healing time was averaged 7.42 (range 5.0-16.0 months) months. There were no significant differences in the healing time and nonunion between the early stage and late stage groups (P > 0.05). In the early stage group, excellent functional recovery of affected limb was observed in 13 patients, good recovery in 11 patients, and fair recovery in 1 patient, and it was 17, 18 and 3 patients respectively in the late stage group. There was no significant difference in functional recovery of affected limbs between early stage and late stage groups (P > 0.05). These results showed that bone grafting within the induced membrane at different time has slight, but not significant effect on healing of bone defect. Other factors, such as the size and the integrity of induced membrane, the quality and quantity of bone graft material, and the stability of bone stumps had more significant effects on the healing of bone defects, in particular on the healing rate.

Key words: induced membrane technique, Masquelet technique, induced membrane, bone defect, bone healing, bone cement, bone graft, induced membrane activity

CLC Number:

Zhou Zihong, Wu Yongwei, Feng Dehong, Zhao Jijun, Gu Sanjun, Xu Yajun, Rui Yongjun, Yin Xiaogen, Yin Qudong. Bone healing effects of early-stage versus late-stage bone grafting within induced membrane[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(4): 493-498.

Figures/Tables 6

References

[1] 周子红,冯德宏,徐可林,等.诱导膜技术的手术失误和并发症:44例感染性骨缺损治疗分析[J].中国组织工程研究, 2018,22(26): 4162-4167.
[2] MORELLI I, DRAGO L, GEORGE D, et al.Masquelet technique: Myth or reality?A systematic review and meta-analysis. Injury. 2016; 47:68-76.
[3] 黄进成,刘曦明,蔡贤华,等.Masquelet技术治疗感染性骨缺损的研究进展[J].中国矫形外科杂志,2017,25(20):1867-1871.
[4] 陈宇杰,周耀东,刘德荣,等.Masquelet技术治疗创伤后骨缺损[J].中华创伤骨科杂志,2013,15(6):540-542.
[5] 殷渠东,顾三军,芮永军,等.诱导膜技术治疗骨缺损的疗效分析[J].中华骨科杂志, 2016,36(20):1284-1293.
[6] PELISSIER P, MASQUELET AC, BAREILLE R, et al.Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res.2004;22(1):73-79.
[7] ZWETYENGA N, CATROS S, EMPARANZA A, et al. Mandibular reconstruction using induced membranes with autologous cancellous bone graft and HA-betaTCP: animal model study and preliminary results in patients.Int J Oral Maxillofac Surg. 2009;38(12):1289-1297.
[8] WONG TM, LAU TW, LI X, et al.Masquelet technique for treatment of posttraumatic bone defects. ScientificWorldJournal.2014;2014:710302.
[9] CHRISTOU C, OLIVER RA, YU Y, et al.The Masquelet technique for membrane induction and the healing of ovine critical sized segmental defects.PLoS One. 2014;9(12): e114122.
[10] PALEY D, HERZENBERG JE, PAREMAIN G, et al.Femoral lengthening over an intramedullary nail.A matched-case comparison with Ilizarov femoral lengthening.J Bone Joint Surg Am.1997;79(10):1464-1480.
[11] KLAUE K, KNOTHE U, ANTON C, et al.Bone regeneration in long-bone defects: tissue compartmentalisation? In vivo study on bone defects in sheep.Injury.2009;40(Suppl 4):S95-102.
[12] DONEGAN DJ, SCOLARO J, MATUSZEWSKI PE, et al. Staged bone grafting following placement of an antibiotic spacer block for the management of segmental long bone defects. Orthopedics. 2011;34(11):e730-735.
[13] 雷鸣,王敏,张催.万古霉素骨水泥对骨折内固定术后髓内感染的疗效观察[J].抗感染药学,2014,11(5):538-540.
[14] MORELLI I, DRAGO L, GEORGE DA, et al.Masquelet technique: myth or reality? A systematic review and meta-analysis. Injury. 2016;47(Suppl 6):S68-S76.
[15] WANG X, WANG Z, FU J, et al.Induced membrane technique for the treatment of chronic hematogenous tibia osteomyelitis. BMC Musculoskelet Disord.2017;18(1):33.
[16] LUO F, WANG X, WANG S, et al.Induced membrane technique combined with two-stage internal fixation for the treatment of tibial osteomyelitis defects.Injury.2017;48(7):1623-1627.
[17] 汪小华,傅景曙,沈杰,等.诱导膜技术治疗胫骨创伤后骨髓炎[J].中华创伤杂志,2015,31(4):299-302.
[18] 李林,林达生,郝健明,等.Masquelet技术治疗胫骨大段骨缺损的疗效分析[J].中华创伤骨科杂志,2014,16(1):88-90.
[19] KONDA SR, GAGE M, FISHER N, et al.Segmental bone defect treated with the induced membrane technique.J Orthop Trauma.2017;31(Suppl 3):S21-S22.
[20] WONG TM, LAU TW, LI X, et al.Masquelet technique for treatment of posttraumatic bone defects. ScientificWorldJournal.2014;2014:710302.
[21] VIATEAU V, GUILLEMIN G, CALANDO Y, et al.Induction of a barrier membrane to facilitate reconstruction of massive segmental diaphyseal bone defects:an ovine model.Vet Surg. 2006; 35(5):445-452.
[22] ZWETYENGA N, CATROS S, EMPARANZA A, et al. Mandibular reconstruction using induced membranes with autologous cancellous bone graft and HA-betaTCP:animal model study and preliminary results in patients.Int J Oral Maxillofac Surg. 2009;38(12):1289-1297.
[23] 李宗原,唐诗添,王军,等.Masquelet技术联合组织瓣移植修复骨软组织复合缺损[J].中国修复重建外科杂志, 2016,30(8): 966-970.
[24] 沈友银,杨月舟,汤龙海,等.利用钛网包裹打压松质骨植骨治疗上肢长骨较长骨缺损[J].中华手外科杂志,2016,32(4):279-230.
[25] 殷渠东,顾三军,芮永军,等.松质骨包裹植骨技术治疗长骨节段性骨缺损:50例报告和文献复习[J].中华创伤骨科杂志, 2017,19(9): 775-781.
[26] APARD T, BIGORRE N, CRONIER P, et al.The mechanism of action of induced membranes in bone repair.J Bone Joint Surg Am. 2013;95(7):597-604.
[27] HENRICH D, SEEBACH C, NAU C, et al.Establishment and characterization of the Masquelet induced membrane technique in a rat femur critical-sized defect model.J Tissue Eng Regen Med.2016;10(10):E382-E396.