诱导膜技术修复骨缺损研究现状及应用方法的改进
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摘要
背景:诱导膜技术具有良好的骨缺损修复效果,与诱导膜的生物成骨活性和机械性包裹作用有关。由于不同时期植骨诱导膜的生物成骨活性相差较大,尤其是在晚期阶段,诱导膜的生物成骨活性较弱,因此,到底是诱导膜的生物成骨活性或是机械性包裹作用对骨缺损修复的作用更大,仍有不同意见。目的:将有关诱导膜技术研究现状和应用方法的改良作一综述。方法:应用计算机检索CNKI数据库、Pub Med数据库及Elsevier数据库中收录的相关文献,中文检索词为"骨缺损,诱导膜,诱导膜技术,骨水泥",英文检索词为"Bone defect,Induced membrane,Induced membrane technique,Bone cement"。查阅1995年1月至2018年12月期间收录的相关文章,包括综述、基础研究及临床研究,通过阅读文题和摘要进行初步筛选,排除与文章主题相关度低的文献,根据纳入标准和排除标准,最终纳入40篇文献进行结果分析。结果与结论:研究表明,诱导膜技术修复骨缺损既有生物成骨活性因素,又有机械性包裹因素。在感染性骨缺损第1阶段手术可以采用内固定,骨水泥填塞物体外成型可以克服体内成型发热性损伤、难取出等缺陷。植骨时机不同,诱导膜成骨活性不同,因此植骨量应考虑到植骨时机,但最佳的植骨量和植骨材料比例尚缺乏实验研究。可降解填塞物的出现,使一次性诱导膜技术手术变为可能,但大多数可降解填塞物的力学强度较差,膜诱导力较弱。期待新的力学强度更好、膜诱导力更强或可促进骨生长的可降解填塞物出现,有望缩短治疗时间和减少自体骨用量。
BACKGROUND: Induced membrane technique has good effect on repair of bone defect, which is related to the bio-osteogenetic activity and mechanical encapsulation of induced membrane. Due to the large difference in bio-osteogenetic activity at different time of bone grafting, especially in the late phase, the bio-osteogenetic activity of the induced membrane is weak.OBJECTIVE: To review the research status and modification of application methods of induced membrane technique for repair of bone defect.METHODS: A computer-based online search of CNKI, Pub Med, and Elsevier databases was performed for retrieving articles concerning the research status and modification of application methods of induced membrane technique for repair of bone defect published from January 1995 to December 2018. The search terms were "bone defect, induced membrane, induced membrane technique, bone cement" in Chinese and English, respectively. The types of literature included review, basic and clinical research. The literature was screened preliminarily by reading title and abstract, and the irrelevant articles were excluded. Finally 40 articles eligible for inclusion and exclusion criteria were enrolled for result analysis RESULTS AND CONCLUSION: The mechanism of induced membrane technique for repair of bone defect includes both biosteogenesis and mechanical encapsulation. Internal fixation can also be used in the first stage of surgery for infected bone defect; bone cement forming in vitro overcomes the shortcomings of fever damage and difficulty in removal. The osteogenetic activity of induced membrane was different at different timing of bone grafting. Therefore, amounts of bone grafting should be required according to different bone grafting times. However,there are few studies on the optimal amount of bone graft and the ratio of bone material. The emergence of degradable spacer makes a single surgery of induced membrane technique possible, but most of the degradable spacers have poor mechanical strength and weak membrane induction ability. It is expected that the emergence of new degradable spacer with better mechanical strength, stronger membrane induction or having the ability to promote bone growth will shorten the treatment time and reduce the amount of bone autograft.
BACKGROUND: Induced membrane technique has good effect on repair of bone defect, which is related to the bio-osteogenetic activity and mechanical encapsulation of induced membrane. Due to the large difference in bio-osteogenetic activity at different time of bone grafting, especially in the late phase, the bio-osteogenetic activity of the induced membrane is weak.OBJECTIVE: To review the research status and modification of application methods of induced membrane technique for repair of bone defect.METHODS: A computer-based online search of CNKI, Pub Med, and Elsevier databases was performed for retrieving articles concerning the research status and modification of application methods of induced membrane technique for repair of bone defect published from January 1995 to December 2018. The search terms were "bone defect, induced membrane, induced membrane technique, bone cement" in Chinese and English, respectively. The types of literature included review, basic and clinical research. The literature was screened preliminarily by reading title and abstract, and the irrelevant articles were excluded. Finally 40 articles eligible for inclusion and exclusion criteria were enrolled for result analysis RESULTS AND CONCLUSION: The mechanism of induced membrane technique for repair of bone defect includes both biosteogenesis and mechanical encapsulation. Internal fixation can also be used in the first stage of surgery for infected bone defect; bone cement forming in vitro overcomes the shortcomings of fever damage and difficulty in removal. The osteogenetic activity of induced membrane was different at different timing of bone grafting. Therefore, amounts of bone grafting should be required according to different bone grafting times. However,there are few studies on the optimal amount of bone graft and the ratio of bone material. The emergence of degradable spacer makes a single surgery of induced membrane technique possible, but most of the degradable spacers have poor mechanical strength and weak membrane induction ability. It is expected that the emergence of new degradable spacer with better mechanical strength, stronger membrane induction or having the ability to promote bone growth will shorten the treatment time and reduce the amount of bone autograft.
引文
[1] Assal M,Stern R.The Masquelet procedure gone away.Orthopedics.2014;37(11):e1045-e1048.
[2]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.
[3]谢利君,李航,潘志军,等.Masquelet诱导膜技术修复胫骨感染性缺损[J].中华创伤骨科杂志,2018,20(10):860-865.
[4] Morelli I,Drago L,George D,et al.Masquelet technique:Myth or reality?A systematic review and meta-analysis. Injury. 2016;47:68-76.
[5]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.
[6] 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.
[7] Cuthbert RJ,Churchman SM,Tan SB,et al.Induced periosteum a complex cellular scaffold for the treatment of large bone defects.Bone.2013;57(2):484-492.
[8] Pelissier P,Masquelet AC,Bareille R,et al.Induced membrance scecrete growth factors includig vascular and osteoinductive factirs and could stimulate bone regeneration.J Orthop Res.2004;22(1):73-79.
[9] 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.2010;35(5):445-452.
[10] 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.
[11]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.
[12]刘欣伟,韩天宇,荆延峰,等.膜诱导技术结合抗生素涂层髓内钉治疗大段感染性骨缺损[J].创伤与急危重病医学, 2017,5(5):257-261.
[13] Karger C,Kishi T,Schneider L,et al.Treatment of posttraumatic bone defects by the induced membrane technique.Orthop Traumatol Surg Res.2012;98(1):97-102.
[14] Stafford PR,Norris BL.Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions:a review of 25 cases.Injury.2010;41(Suppl 2):S72.
[15]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.
[16]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.
[17]周密,徐建强,李长庚,等.PLGA-TCP-BMP-2人工骨结合带血供自体骨修复骨缺损[J].中国矫形外科杂志,2011,19(10):846-848.
[18]王进辉,潘海乐.抗生素骨水泥的研究现状[J].中国矫形外科杂志,2009,17(6):439-442.
[19]魏富达,汪小华,谢肇. PMMA骨水泥与磷酸钙骨水泥诱导成膜及其对成骨活性的差异[J].第三军医大学学报,2015,37(10):973-977.
[20] Spapen HD,Janssen v DK,Diltoer M,et al.Retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients. Ann Intensive Care. 2011 19;1(1):26.
[21] Nau C,Seebach C,Trumm A,et al.Alteration of Masquelet induced membrane characteristics by different kinds of antibiotics enriched bone cement in a critical size defect model in the rat’s femur.Injury.2016;47(2):325-334.
[22]殷渠东,顾三军,孙振中,等.诱导膜在感染性骨缺损治疗中的作用观察[J].中国临床解剖学杂志,2017,35(4):459-463.
[23] Yu X,Wu H,Li J,et al.Antibiotic cement-coated locking plate as a temporary internal fixator for femoral osteomyelitis defects.Int orthop.2017;41(9):1-7.
[24]余鑫,贾硕,吴宏日,等.抗生素骨水泥被覆锁定钢板在膜诱导技术治疗胫骨创伤后骨感染中的运用[J].中华创伤杂志, 2017,33(6):539-554.
[25]丁国成,刘欣伟,刘兵,等.膜诱导技术结合被覆抗生素骨水泥髓内钉治疗下肢感染性骨缺损[J].中华骨科杂志, 2018,38(9):530-535.
[26] Liporace FA,Yoon RS,Frank MA,et al.Use of an “antibiotic plate"for infected periprosthetic fracture in total hip arthroplasty.J Orthop Trauma.2012;26(3):18-23.
[27]殷渠东,顾三军,孙振中,等.Masquelet技术中体外制作骨水泥填塞物的临床应用[J].中华创伤杂志, 2016,32(4):370-372.
[28]张辉,殷渠东,顾三军,等.空心多孔抗生素骨水泥体外成形、体内灌洗的诱导膜技术治疗骨髓炎[J].中国修复重建外科杂志, 2015,29(11):1397-1400.
[29] Jiang N,Qin CH,Ma YFet al.Possibility of one-stage surgery to reconstruct bone defects using the modified Masquelet technique with degradable calcium sulfate as a cement spacer:A case report and hypothesis.Biomed Rep. 2016;4(3):374-378.
[30] Ding SJ,Shie MY,Wang CY.Novel fast-setting calcium silicate bone cement with high bioactivity and enhanced osteogenesis in vitro.J Mater Chem.2009;19(8):1183-1190.
[31] Walsh WR,Morbergn P,Yu Y.et al.Response of a calcium sulfate bone graft substitute in a confined cancellous defect.Clin Orthop Relat Res.2003;(406):228-236.
[32] RomanòCL,Logoluso N,Meani E,et al.R.A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis:a retrospective comparative study.Bone Joint J.2014;96B(6):845-850.
[33] Dashti A,Ready D,Salih V,et al.In vitro antibacterial efficacy of tetracycline hydrochloride adsorbed onto Bio-Oss?bone graft.J Biomed Mater Res B Appl Biomater. 2010;93(2):394-400.
[34] Tiago Silva,Liliana Grenho,Joana Barros,et al.A minocycline-releasing PMMA system as a space maintainer for staged bone reconstructions—in vitro antibacterial,cytocompatibility and anti-inflammatory characterization.Biomedical Materials.2017;12(3):035009.
[35] Fernandez de Grado G,Keller L,Idoux-Gillet Y,et al.Bone substitutes:a review of their characteristics,clinical use,and perspectives for large bone defects management.J Tissue Eng.2018;9:2041731418776819.
[36] Azi ML,Teixeira A,Cotias RB,et al.Membrane induced osteogenesis in the management of post-traumatic bone defects.J Orthopaedic Trauma.2016;30(10):545.
[37] 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(3):101-105.
[38] Gupta G,Ahmad S,Mohd Zahid,et al.Management of traumatic tibial diaphyseal bone defect by"induced-membrane technique".Indian J Orthop.2016;50(3):290-296.
[39]韩晓飞,刘宇,徐可林,等.联合取骨诱导膜、线网与钛网包裹植骨治疗大段骨缺损[J].中国组织工程研究,2018,22(30):4782-4787.
[40] Giannoudis PV,Gudipati S,Harwood P,et al.Long bone non-unions treated with the diamond concept:a case series of 64 patients.Injury.2015;46(Supple8):S48-S54.
[2]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.
[3]谢利君,李航,潘志军,等.Masquelet诱导膜技术修复胫骨感染性缺损[J].中华创伤骨科杂志,2018,20(10):860-865.
[4] Morelli I,Drago L,George D,et al.Masquelet technique:Myth or reality?A systematic review and meta-analysis. Injury. 2016;47:68-76.
[5]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.
[6] 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.
[7] Cuthbert RJ,Churchman SM,Tan SB,et al.Induced periosteum a complex cellular scaffold for the treatment of large bone defects.Bone.2013;57(2):484-492.
[8] Pelissier P,Masquelet AC,Bareille R,et al.Induced membrance scecrete growth factors includig vascular and osteoinductive factirs and could stimulate bone regeneration.J Orthop Res.2004;22(1):73-79.
[9] 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.2010;35(5):445-452.
[10] 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.
[11]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.
[12]刘欣伟,韩天宇,荆延峰,等.膜诱导技术结合抗生素涂层髓内钉治疗大段感染性骨缺损[J].创伤与急危重病医学, 2017,5(5):257-261.
[13] Karger C,Kishi T,Schneider L,et al.Treatment of posttraumatic bone defects by the induced membrane technique.Orthop Traumatol Surg Res.2012;98(1):97-102.
[14] Stafford PR,Norris BL.Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions:a review of 25 cases.Injury.2010;41(Suppl 2):S72.
[15]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.
[16]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.
[17]周密,徐建强,李长庚,等.PLGA-TCP-BMP-2人工骨结合带血供自体骨修复骨缺损[J].中国矫形外科杂志,2011,19(10):846-848.
[18]王进辉,潘海乐.抗生素骨水泥的研究现状[J].中国矫形外科杂志,2009,17(6):439-442.
[19]魏富达,汪小华,谢肇. PMMA骨水泥与磷酸钙骨水泥诱导成膜及其对成骨活性的差异[J].第三军医大学学报,2015,37(10):973-977.
[20] Spapen HD,Janssen v DK,Diltoer M,et al.Retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients. Ann Intensive Care. 2011 19;1(1):26.
[21] Nau C,Seebach C,Trumm A,et al.Alteration of Masquelet induced membrane characteristics by different kinds of antibiotics enriched bone cement in a critical size defect model in the rat’s femur.Injury.2016;47(2):325-334.
[22]殷渠东,顾三军,孙振中,等.诱导膜在感染性骨缺损治疗中的作用观察[J].中国临床解剖学杂志,2017,35(4):459-463.
[23] Yu X,Wu H,Li J,et al.Antibiotic cement-coated locking plate as a temporary internal fixator for femoral osteomyelitis defects.Int orthop.2017;41(9):1-7.
[24]余鑫,贾硕,吴宏日,等.抗生素骨水泥被覆锁定钢板在膜诱导技术治疗胫骨创伤后骨感染中的运用[J].中华创伤杂志, 2017,33(6):539-554.
[25]丁国成,刘欣伟,刘兵,等.膜诱导技术结合被覆抗生素骨水泥髓内钉治疗下肢感染性骨缺损[J].中华骨科杂志, 2018,38(9):530-535.
[26] Liporace FA,Yoon RS,Frank MA,et al.Use of an “antibiotic plate"for infected periprosthetic fracture in total hip arthroplasty.J Orthop Trauma.2012;26(3):18-23.
[27]殷渠东,顾三军,孙振中,等.Masquelet技术中体外制作骨水泥填塞物的临床应用[J].中华创伤杂志, 2016,32(4):370-372.
[28]张辉,殷渠东,顾三军,等.空心多孔抗生素骨水泥体外成形、体内灌洗的诱导膜技术治疗骨髓炎[J].中国修复重建外科杂志, 2015,29(11):1397-1400.
[29] Jiang N,Qin CH,Ma YFet al.Possibility of one-stage surgery to reconstruct bone defects using the modified Masquelet technique with degradable calcium sulfate as a cement spacer:A case report and hypothesis.Biomed Rep. 2016;4(3):374-378.
[30] Ding SJ,Shie MY,Wang CY.Novel fast-setting calcium silicate bone cement with high bioactivity and enhanced osteogenesis in vitro.J Mater Chem.2009;19(8):1183-1190.
[31] Walsh WR,Morbergn P,Yu Y.et al.Response of a calcium sulfate bone graft substitute in a confined cancellous defect.Clin Orthop Relat Res.2003;(406):228-236.
[32] RomanòCL,Logoluso N,Meani E,et al.R.A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis:a retrospective comparative study.Bone Joint J.2014;96B(6):845-850.
[33] Dashti A,Ready D,Salih V,et al.In vitro antibacterial efficacy of tetracycline hydrochloride adsorbed onto Bio-Oss?bone graft.J Biomed Mater Res B Appl Biomater. 2010;93(2):394-400.
[34] Tiago Silva,Liliana Grenho,Joana Barros,et al.A minocycline-releasing PMMA system as a space maintainer for staged bone reconstructions—in vitro antibacterial,cytocompatibility and anti-inflammatory characterization.Biomedical Materials.2017;12(3):035009.
[35] Fernandez de Grado G,Keller L,Idoux-Gillet Y,et al.Bone substitutes:a review of their characteristics,clinical use,and perspectives for large bone defects management.J Tissue Eng.2018;9:2041731418776819.
[36] Azi ML,Teixeira A,Cotias RB,et al.Membrane induced osteogenesis in the management of post-traumatic bone defects.J Orthopaedic Trauma.2016;30(10):545.
[37] 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(3):101-105.
[38] Gupta G,Ahmad S,Mohd Zahid,et al.Management of traumatic tibial diaphyseal bone defect by"induced-membrane technique".Indian J Orthop.2016;50(3):290-296.
[39]韩晓飞,刘宇,徐可林,等.联合取骨诱导膜、线网与钛网包裹植骨治疗大段骨缺损[J].中国组织工程研究,2018,22(30):4782-4787.
[40] Giannoudis PV,Gudipati S,Harwood P,et al.Long bone non-unions treated with the diamond concept:a case series of 64 patients.Injury.2015;46(Supple8):S48-S54.