利用诱导膜技术改进小儿骨缺失重建术

IF 1.4 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2024-09-01 Epub Date: 2024-06-03 DOI:10.1097/BPO.0000000000002736
Alexandra M Stein, Alina Badina, Stéphanie Pannier, Elie Saghbini, Frank Fitoussi
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引用次数: 0

摘要

背景:目前,诱导膜技术已被广泛用于治疗因各种病因引起的小儿骺端骨缺损。虽然巩固率仍然令人满意,但可能会出现并发症和愈合延迟,需要进行额外的手术。我们对一系列诱导膜骨重建进行了研究,其中第二阶段除了髂骨移植物外,还包括嵌入内膜的无血管腓骨轴。本研究的目的是分析骨巩固和并发症方面的结果:这是一项回顾性比较和多中心研究,研究对象是采用诱导膜重建技术治疗大面积骨缺失的 32 名儿童。根据第二阶段使用的移植物将患者分为两组。第一组(G1)的 16 名患者在膜内嵌入了无血管的腓骨,并从髂嵴移植了皮质冠状植骨。第二组(G2)的 16 名患者采用原始技术进行重建,仅使用髂嵴移植物:两组患者的骨质流失病因和随访情况相似(G1 组平均 44 个月,G2 组平均 49 个月)。G1 组的平均骨量损失为 15.4 厘米(范围:2 至 25;标度:5.6),G2 组的平均骨量损失为 10.6 厘米(范围:3 至 19;标度:5.2)。在第一组中,所有患者都基本痊愈,平均痊愈时间为 5.9 个月(范围:4 至 8;标准差:1.6)。在第二组中,16 位患者中有 2 位没有痊愈;其他 14 位患者的平均痊愈时间为 6.9 个月(范围:3 至 12;标准差:2.7)。G1 组的短期和长期并发症发生率分别为 38% 至 19%,G2 组为 50% 至 31%。关于供体部位,腓骨自发重建的平均时间为4.8个月(范围:3至6个月;标准差:1.2个月):结论:在诱导膜技术的第二阶段整合无血管的腓骨似乎能提高儿童的巩固率:证据等级:III级--回顾性比较研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Improvements in Pediatric Bone Loss Reconstruction With the Induced Membrane Technique.

Background: The induced membrane technique is now widely used for pediatric diaphyseal bone loss due to various etiologies. Although consolidation rates remain satisfactory, complications, and healing delays may occur requiring additional procedures. We studied a series of induced membrane bone reconstructions in which the second stage included an embedded endomembranous non vascularized fibular shaft, in addition to iliac bone grafts. The purpose of this study was to analyze the results in terms of bone consolidation and complications.

Methods: This is a retrospective comparative and multicentric study of 32 children with large bone loss treated with the induced membrane reconstruction technique. Patients were divided into 2 groups according to the graft used during the second stage. The first group (G1) of 16 patients had a nonvascularized fibula embedded inside the membrane in addition with the corticocancellous grafts from the iliac crest. The second group (G2) of 16 patients underwent reconstruction using the original technique, with iliac crest graft only.

Results: The 2 groups were similar in terms of etiologies of bone loss and follow-up (mean: 44 mo for G1 and 49 mo for G2). Mean bone losses were 15.4 cm (range: 2 to 25; SD: 5.6) for G1 and 10.6 cm (range: 3 to 19; SD: 5.2) for G2. In the first group, all patients healed primarily, with a mean time of 5.9 months (range: 4 to 8; SD: 1.6). In the second group, 2 of 16 patients did not healed; for the others 14, healing mean time was 6.9 months (range: 3 to 12; SD: 2.7). The short-term and long-term complications rates were 38% to 19% for G1 and 50% to 31% for G2, respectively. Regarding the donor site, the fibulas reconstructed spontaneously with a mean time of 4.8 months (range: 3 to 6; SD: 1.2).

Conclusions: The integration of a nonvascularized fibula during the second stage of the induced membrane technique appears to improve the consolidation rate in the pediatric population.

Level of evidence: Level III-Retrospective comparative study.

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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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