Masquelet技术治疗骨折后骨缺损疗效的荟萃分析
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摘要
[目的]系统评价Masquelet技术治疗创伤后骨缺损的治愈率及并发症的发生率。[方法]计算机检索Pubmed、EMbase、SCI、OVID循证数据库,收集Masquelet技术治疗骨折后骨缺损的研究,检索时间从建库至2018年4月。由2名研究者独立收集、筛选文献、提取资料,采用STATA12.0软件,依据效应指标为率的单臂研究荟萃分析方法进行分析。[结果]共纳入21个研究,包括594例患者。荟萃分析结果表明:融合所有研究报道的结果,Masquelet技术治疗骨折后骨缺损的治愈率为87.8%(CI 95%:84.9%～90.4%);术后再感染的发生率为9.2%(CI95%:5.3%～14%);术后骨不连的发生率为5.7%(CI 95%:2.8%～9.5%)。[结论]应用Masquelet技术治疗创伤后骨缺损有很高的治愈率,但仍然存在不容忽视的感染复发和骨不愈合的风险。
[Objective] To explore the healing and complication rate of Masquelet technique for post-traumatic bone defect by a meta-analysis. [Methods] Theses on Masquelet technique for post-traumatic bone defect were retrieved from Electronic databases, including PubMed, EMBASE SCI and OVID from beginning to April 2018. The literature were independently evaluated and collectively brought in by two reviewers, and then a meta-analysis was conducted based on single-arm design for the effect indicator as rate using STATA12.0 software. [Results] A total of 21 studies involving 594 patients were included into this study. The meta-analysis showed that the consolidated healing rate of bone defects managed by Masquelet technique was of(87.8%, CI 95%:84.9%～90.4%), while the reinfection rate proved of(9.2%, CI 95%:5.3%～14%), and nonunion rate of(5.7%, CI 95%:2.8%～9.5%). [Conclusion] The induced membrane technique might be effective treatment for post-traumatic bone defects, however, the risks of reinfection and nonunion could not be neglected.
[Objective] To explore the healing and complication rate of Masquelet technique for post-traumatic bone defect by a meta-analysis. [Methods] Theses on Masquelet technique for post-traumatic bone defect were retrieved from Electronic databases, including PubMed, EMBASE SCI and OVID from beginning to April 2018. The literature were independently evaluated and collectively brought in by two reviewers, and then a meta-analysis was conducted based on single-arm design for the effect indicator as rate using STATA12.0 software. [Results] A total of 21 studies involving 594 patients were included into this study. The meta-analysis showed that the consolidated healing rate of bone defects managed by Masquelet technique was of(87.8%, CI 95%:84.9%～90.4%), while the reinfection rate proved of(9.2%, CI 95%:5.3%～14%), and nonunion rate of(5.7%, CI 95%:2.8%～9.5%). [Conclusion] The induced membrane technique might be effective treatment for post-traumatic bone defects, however, the risks of reinfection and nonunion could not be neglected.
引文
[1]余斌,马云飞,姜楠,等.Masquelet技术基础及临床应用研究进展[J].中华创伤骨科杂志,2015,17(10):879-883.
[2]张天嵩.高级Meta分析方法:基于Stata实现[M].北京:复旦大学出版社,2015:141-152.
[3]Apard T,Bigorre N,Cronier P,et al.Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing[J].Orthop Traumatol Surg Res,2010,96(5):549-553.
[4]Masquelet A C,Begue T.The concept of induced membrane for reconstruction of long bone defects[J].Orthop Clin North Am,2010,41(1):27-37.
[5]Stafford PR,Norris BL.Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions:a review of 25 cases[J].Injury,2010,41(Suppl 2):S72-S77.
[6]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[J].Orthopedics,2011,34(11):e730-e735.
[7]Karger C,Kishi T,Schneider L,et al.Treatment of posttraumatic bone defects by the induced membrane technique[J].Orthop Traumatol Surg Res,2012,98(1):97-102.
[8]El-Alfy BS,Ali AM.Management of segmental skeletal defects by the induced membrane technique[J].2015,49(6):643-648.
[9]Moghaddam A,Zietzschmann S,Bruckner T,et al.Treatment of atrophic tibia non-unions according to'diamond concept':results of one-and two-step treatment[J].Injury,2015,46(Suppl 4):S39-S50.
[10]Olesen UK,Eckardt H,Bosemark P,et al.The Masquelet technique of induced membrane for healing of bone defects.A review of 8 cases[J].Injury,2015,46(Suppl 8):S44-S47.
[11]Scholz AO,Gehrmann S,Glombitza M,et al.Reconstruction of septic diaphyseal bone defects with the induced membrane technique[J].Injury,2015,46(Suppl 4):S121-S124.
[12]Taylor BC,Hancock J,Zitzke R,et al.Treatment of bone loss with the induced membrane technique:techniques and outcomes[J].JOrthop Trauma,2015,29(12):554-557.
[13]Azi ML,Teixeira AA,Cotias RB,et al.Membrane induced osteogenesis in the management of posttraumatic bone defects[J].J Orthop Trauma,2016,30(10):545-550.
[14]Giannoudis PV,Harwood PJ,Tosounidis T,et al.Restoration of long bone defects treated with the induced membrane technique:protocol and outcomes[J].Injury,2016,47:S53-S61.
[15]Gupta G,Ahmad S,Mohd Z,et al.Management of traumatic tibial diaphyseal bone defect by"induced-membrane technique"[J].Indian J Orthop,2016,50(3):290-296.
[16]Miska M,Findeisen S,Tanner M,et al.Treatment of nonunions in fractures of the humeral shaft according to the Diamond Concept[J].Bone Joint J,2016,98-b(1):81-87.
[17]Obert L,Rondot T,Cheval D,et al.Application of the induced membrane in the acute setting of bone loss[J].Tech Orthop,2016,31(1):23-28.
[18]Wang X,Luo F,Huang K,et al.Induced membrane technique for the treatment of bone defects due to post-traumatic osteomyelitis[J].Bone Joint Res,2016,5(3):101-105.
[19]Cho JW,Kim J,Cho WT,et al.Circumferential bone grafting around an absorbable gelatin sponge core reduced the amount of grafted bone in the induced membrane technique for critical-size defects of long bones[J].Injury,2017,48(10):2292-2305.
[20]Luo F,Wang X,Wang S,et al.Induced membrane technique combined with two-stage internal fixation for the treatment of tibial osteomyelitis defects[J].Injury,2017,48(7):1623-1627.
[21]Ma CH,Chiu YC,Tsai KL,et al.Masquelet technique with external locking plate for recalcitrant distal tibial nonunion[J].Injury,2017,48(12):2847-2852.
[22]Muhlhausser J,Winkler J,Babst R,et al.Infected tibia defect fractures treated with the Masquelet technique[J].Medicine,2017,96(20):e6948.
[23]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[J].Int Orthop,2018,42(1):17-24.
[24]李林,林达生,练克俭,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.(收稿:2018-08-16)
[2]张天嵩.高级Meta分析方法:基于Stata实现[M].北京:复旦大学出版社,2015:141-152.
[3]Apard T,Bigorre N,Cronier P,et al.Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing[J].Orthop Traumatol Surg Res,2010,96(5):549-553.
[4]Masquelet A C,Begue T.The concept of induced membrane for reconstruction of long bone defects[J].Orthop Clin North Am,2010,41(1):27-37.
[5]Stafford PR,Norris BL.Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions:a review of 25 cases[J].Injury,2010,41(Suppl 2):S72-S77.
[6]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[J].Orthopedics,2011,34(11):e730-e735.
[7]Karger C,Kishi T,Schneider L,et al.Treatment of posttraumatic bone defects by the induced membrane technique[J].Orthop Traumatol Surg Res,2012,98(1):97-102.
[8]El-Alfy BS,Ali AM.Management of segmental skeletal defects by the induced membrane technique[J].2015,49(6):643-648.
[9]Moghaddam A,Zietzschmann S,Bruckner T,et al.Treatment of atrophic tibia non-unions according to'diamond concept':results of one-and two-step treatment[J].Injury,2015,46(Suppl 4):S39-S50.
[10]Olesen UK,Eckardt H,Bosemark P,et al.The Masquelet technique of induced membrane for healing of bone defects.A review of 8 cases[J].Injury,2015,46(Suppl 8):S44-S47.
[11]Scholz AO,Gehrmann S,Glombitza M,et al.Reconstruction of septic diaphyseal bone defects with the induced membrane technique[J].Injury,2015,46(Suppl 4):S121-S124.
[12]Taylor BC,Hancock J,Zitzke R,et al.Treatment of bone loss with the induced membrane technique:techniques and outcomes[J].JOrthop Trauma,2015,29(12):554-557.
[13]Azi ML,Teixeira AA,Cotias RB,et al.Membrane induced osteogenesis in the management of posttraumatic bone defects[J].J Orthop Trauma,2016,30(10):545-550.
[14]Giannoudis PV,Harwood PJ,Tosounidis T,et al.Restoration of long bone defects treated with the induced membrane technique:protocol and outcomes[J].Injury,2016,47:S53-S61.
[15]Gupta G,Ahmad S,Mohd Z,et al.Management of traumatic tibial diaphyseal bone defect by"induced-membrane technique"[J].Indian J Orthop,2016,50(3):290-296.
[16]Miska M,Findeisen S,Tanner M,et al.Treatment of nonunions in fractures of the humeral shaft according to the Diamond Concept[J].Bone Joint J,2016,98-b(1):81-87.
[17]Obert L,Rondot T,Cheval D,et al.Application of the induced membrane in the acute setting of bone loss[J].Tech Orthop,2016,31(1):23-28.
[18]Wang X,Luo F,Huang K,et al.Induced membrane technique for the treatment of bone defects due to post-traumatic osteomyelitis[J].Bone Joint Res,2016,5(3):101-105.
[19]Cho JW,Kim J,Cho WT,et al.Circumferential bone grafting around an absorbable gelatin sponge core reduced the amount of grafted bone in the induced membrane technique for critical-size defects of long bones[J].Injury,2017,48(10):2292-2305.
[20]Luo F,Wang X,Wang S,et al.Induced membrane technique combined with two-stage internal fixation for the treatment of tibial osteomyelitis defects[J].Injury,2017,48(7):1623-1627.
[21]Ma CH,Chiu YC,Tsai KL,et al.Masquelet technique with external locking plate for recalcitrant distal tibial nonunion[J].Injury,2017,48(12):2847-2852.
[22]Muhlhausser J,Winkler J,Babst R,et al.Infected tibia defect fractures treated with the Masquelet technique[J].Medicine,2017,96(20):e6948.
[23]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[J].Int Orthop,2018,42(1):17-24.
[24]李林,林达生,练克俭,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.(收稿:2018-08-16)