Masquelet technique in treatment of infectious nonunion: a meta-analysis

doi:10.3969/j.issn.2095-4344.3822

Abstract

Abstract: OBJECTIVE: At present, a large number of clinical studies have confirmed that Masquelet technology is effective and safe in the treatment of infectious bone nonunion, but most studies belong to retrospective case analysis, and the sample size is small, and there is still insufficient evidence-based evidence. Meta-analysis in the effectiveness and safety of Masquelet technique in treating infectious nonunion was conducted.
METHODS: A computer was used to comprehensively search PubMed, Embase, The Cochrane Libraray, Web of Science and China Biology Medicine Database, CNKI, Wanfang, and VIP databases for randomized or non-randomized controlled trials of Masquelet technique in the treatment of infectious nonunion published from inception to May to 2020. After literature screening, data extraction, and quality evaluation according to inclusion and exclusion criteria, RevMan 5.3 software was used to perform meta-analysis of outcome indicators.
RESULTS: (1) A total of 12 articles were included, all of which were non-randomized controlled studies. According to the MINORS scoring scale, five articles were high-quality articles and seven articles were medium-quality articles. (2) Meta-analysis showed that: compared with Ilizarov group, average postoperative healing time (MD=-9.80, 95%CI:-14.17 to -5.43), complication rate (RR=0.44, 95%CI:0.35-0.55), and medical expenses (MD=-0.70, 95%CI:-1.13 to -0.28) were statistically significant in the Masquelet group (P < 0.05). However, excellent and good rate of clinical efficacy, excellent and good rate of affected limb function, and number of operations were not statistically significant between the two groups (P > 0.05). (3) Compared with the stage I bone graft group, the Masquelet group had a significant difference in the bone healing rate (RR=1.37, 95%CI:1.15-1.62, P=0.000 4) (P < 0.05), but complication rate and infection control rate were not statistically significant between them (P > 0.05).
CONCLUSION: Both Masquelet technique and Ilizarov technique can achieve good curative effect in the treatment of infectious bone nonunion. However, compared with Ilizarov technique, Masquelet technique has the advantages of fewer complications, shorter healing time and lower cost, and the bone healing rate is better than the first-stage bone graft. Thus, Masquelet technology is a reliable and safe treatment for infectious nonunion, but this conclusion needs more high-quality, multi-center, large-sample randomized controlled studies to further confirm.

Key words: bone, bone marrow, bone defect, osteomyelitis, nonunion, infection, stage I bone graft, meta-analysis

CLC Number:

Xu Canhong, Meng Lin, Dong Panfeng, Zhan Huasong, Song Shilei. Masquelet technique in treatment of infectious nonunion: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(15): 2445-2452.

Figures/Tables 16

References

[1] TARNG YW, LIN KC. Management of bone defects due to infected non-union or chronic osteomyelitis with autologous non-vascularized free fibular grafts. Injury. 2020;51:294-300.
[2] DHAR SA, DAR TA, MIR NA. Management of Infected Nonunion of the Forearm by the Masquelet Technique. Strategies Trauma Limb Reconstr. 2019;14:1-5.
[3] MOTSITSI NS. Management of infected nonunion of long bones: the last decade (1996-2006). Injury. 2008;39:155-160.
[4] KHANFOUR AA, EL-SAYED MM. Efficacy of a compliant semicircular Ilizarov pin fixator module for treating infected nonunion of the femoral diaphysis. Strategies Trauma Limb Reconstr. 2014;9:101-9.
[5] STRUIJS PA, POOLMAN RW, BHANDARI M, et al. Infected Nonunion of the Long Bones. J Orthop Trauma. 2007;21(7):507-511.
[6] SCHMAL H, BRIX M, BUE M, et al. Nonunion-consensus from the 4th annual meeting of the Danish Orthopaedic Trauma Society. EFORT Open Rev. 2020;5:46-57.
[7] WANG J, YIN Q, GU S, et al. Induced membrane technique in the treatment of infectious bone defect: a clinical analysis. Orthop Traumatol Surg Res. 2019;105: 535-539.
[8] MASQUELET AC, FITOUSSI F, BEGUE T, et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Hast Esthet. 2000;45(3):346-353.
[9] KONDA SR, GAGE M, FISHER N, et al. Segmental bone defect treated with the induced membrane technique. J Orthop Trauma. 2017;31:S21-S22.
[10] Masquelet AC. Induced membrane technique: pearls and pitfaIls. J Orthop Trauma. 2017;31:S36-S38.
[11] WALKER M, SHARAREH B, MITCHEIL SA. Masquelet Reconstruction for Posttraumatic Segmental Bone Defects in the Forearm. J Hand Surg Am. 2019;44:342.e1-342.e8.
[12] GIANNOUDIS PV, HARWOOD PJ, TOSOUNIDIS T, et al. Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes. Injury. 2016;47S6:S53-S61.
[13] 王建兵,顾三军,周子红,等.骨搬运与诱导膜技术修复胫骨大段骨缺损的疗效比较[J].中华创伤骨科杂志, 2019,21(5): 398-404.
[14] 黄纯波,夏先强,刘永峰.Masquelet和Ilizarov技术治疗感染性骨不连的临床效果比较[J].检验医学与临床,2019,16(4): 523-525.
[15] 吴俊学,李毓灵,陈果.Ilizarov技术与Masquelet技术治疗股骨感染性骨不连的疗效[J].西部医学,2019,31(8):1237-1241.
[16] 王智黔,张一,王远政,等.Masquelet技术与一期骨移植治疗感染性骨缺损的炎症控制效果比较[J].中国现代医学杂志, 2018,28(24):108-113.
[17] 耿磊,程前勇,董志远.Masquelet术与Ilizarov骨搬移术治疗感染性骨缺损的疗效比较[J].中国骨与关节损伤杂志,2019, 34(10):1094-1096.
[18] 李树源,周琦石,陈超,等.诱导膜技术与骨搬运技术治疗胫骨创伤性骨髓炎的疗效比较[J].中国中医骨伤科杂志,2019, 27(1):17-21.
[19] TONG K, ZHONG Z, PENG Y, et al. Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects foIlowing posttraumatic osteomyelitis. Injury. 2017;48(7):1616-1622.
[20] 孙志波,郭骏,陈荣,等.Masquelet技术与Ilizarov技术治疗成人胫骨慢性骨髓炎的早期临床疗效比较[J].骨科,2017,8(5): 349-353,359.
[21] 郭佳琪.感染性骨不愈合中应用Masquelet技术与Ilizarov技术的疗效分析[D].太原:山西医科大学,2019.
[22] 石杰.Ilizarov技术与Masquelet技术治疗感染性骨不连骨缺损的疗效分析[D].兰州:甘肃中医药大学,2017.
[23] 杨礼丹.Masquelet与Ilizarov技术治疗成人下肢长骨慢性感染性骨缺损临床疗效分析[D].遵义:遵义医学院,2018.
[24] 喻胜鹏.Masquelet技术与Ⅰ期骨移植治疗下肢创伤后骨髓炎的疗效比较[D].重庆:第三军医大学,2014.
[25] TOTH Z, ROI M, EVANS E, et al. Masquelet technique: effects of spacer material and micro-topography on factor expression and bone regeneration. Ann Biomed Eng. 2019;47:174-189.
[26] SASAKI G, WATANABE Y, MIYAMOTO W, et al. Induced membrane technique using beta-tricalcium phosphate for reconstruction of femoral and tibial segmental bone loss due to infection: technical tips and preliminary clinical results. Int Orthop. 2018;42:17-24.
[27] SLIM K, NINI E, FORESTIER D, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73:712-716.
[28] LUCARELLI E, DONATI D, CENACCHI A, et al. Bone reconstruction of large defects using bone marrow derived autologous stem cells. Transfus Apher Sci. 2004;30(2): 169-174.
[29] MA CH, CHIU YC, TU YK, et al. Three-stage treatment protocol for recalcitrant distal femoral nonunion. Arch Orthop Trauma Surg. 2017;137:489-498.
[30] KOVOOR CC, JAYAKUMAR R, GEORGE V, et al. Vascularized fibular graft in infected tibial bone loss. Indian J Orthop. 2011;45: 330-335.
[31] EL-HADIDI TT, SOLIMAN HM, FAROUK HA, et al. Staged bone grafting for the management of segmental long bone defects caused by trauma or infection using induced-membrane technique. Acta Orthop. Belg. 2018;84:384-396.
[32] KHAN MS, RASHID H, UMER M, et al. Salvage of infected non-union of the tibia with an Ilizarov ring fixator. J Orthop Surg (Hong Kong). 2015;23:52-55.
[33] WANG H, WEI X, LIU P, et al. Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia. Medicine (Baltimore). 2017;96:e8569.
[34] YIN P, JI Q, LI T, et al. A systematic review and meta-analysis of ilizarov methods in the treatment of infected nonunion of tibia and femur. PLoS One. 2015;10:e0141973.
[35] SIDDIQUI AA, SIDDIQUI F, BASHAR M, et al. Impact of ilizarov fixation technique on the limb functionality and self-esteem of patients with unilateral tibial fractures. Cureus. 2019;11:e5923.
[36] YU YH, LEE D, HSU YH, et al. A Three-dimensional printed polycaprolactone scaffold combined with co-axially electrospun vancomycin/ceftazidime/bone morphological protein-2 sheath-core nanofibers for the repair of segmental bone defects during the masquelet procedure. Int J Nanomedicine. 2020;15:913-925.
[37] BOSEMARK P , PERDIKOURI C , PELKONEN M, et al. The masquelet induced membrane technique with BMP and a synthetic scaffold can heal a rat femoral critical size defect. J Orthop Res. 2015;33(4):488-495.
[38] GUPTA S, MALHOTRA A, JINDAL R, et al. Role of beta tri-calcium phosphate-based composite ceramic as bone-graft expander in masquelet’s-induced membrane technique. Indian J Orthop. 2019;53:63-69.
[39] MI M, PAPAKOSTIDIS C, WU X, et al. Mixed results with the masquelet technique: a fact or a myth? Injury. 2020;51:132-135.
[40] SIKARY AK, KUMAR M, DHAKA S, et al. A rare fatal complication of ilizarov procedure. J Forensic Sci. 2018;63:1895-1898.
[41] 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.
[42] YEGANEH A, MAHMODI M, FARAHINI H, et al. Short-term outcomes of induced membrane technique in treatment of long bone defects in Iran. Med Arch. 2016;70: 284-287.
[43] WANG X, LUO F, HUANG K, et al. Induced membrane technique for the treatment of bone defects due to post-traumatic osteomyelitis. Bone Joint Res. 2016;5: 101-105.
[44] SAXER F, ECKARDT H. Rekonstruktion ossärer defekte mit der masquelet-technik. Der Orthopäde. 2017;46(8):665-672.
[45] AHO OM, LEHENKARI P, RISTINIEMI J, et al. The mechanism of action of induced membranes in bone repair. J Bone Joint Surg Am. 2013;95:597-604.