Jie Shen, Zhiyuan Wei, Shulin Wang, Xiaohua Wang, Wei Lin, Lei Liu, Guanglin Wang
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引用次数: 1
Abstract
Aims: This study aimed to evaluate the effectiveness of the induced membrane technique for treating infected bone defects, and to explore the factors that might affect patient outcomes.
Methods: A comprehensive search was performed in PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases between 1 January 2000 and 31 October 2021. Studies with a minimum sample size of five patients with infected bone defects treated with the induced membrane technique were included. Factors associated with nonunion, infection recurrence, and additional procedures were identified using logistic regression analysis on individual patient data.
Results: After the screening, 44 studies were included with 1,079 patients and 1,083 segments of infected bone defects treated with the induced membrane technique. The mean defect size was 6.8 cm (0.5 to 30). After the index second stage procedure, 85% (797/942) of segments achieved union, and 92% (999/1,083) of segments achieved final healing. The multivariate analysis with data from 296 patients suggested that older age was associated with higher nonunion risk. Patients with external fixation in the second stage had a significantly higher risk of developing nonunion, increasing the need for additional procedures. The autografts harvested from the femur reamer-irrigator-aspirator increased nonunion, infection recurrence, and additional procedure rates.
Conclusion: The induced membrane technique is an effective technique for treating infected bone defects. Internal fixation during the second stage might effectively promote bone healing and reduce additional procedures without increasing infection recurrence. Future studies should standardize individual patient data prospectively to facilitate research on the affected patient outcomes.
目的:本研究旨在评价诱导膜技术治疗感染性骨缺损的有效性,并探讨可能影响患者预后的因素。方法:在2000年1月1日至2021年10月31日期间,在PubMed、Embase和Cochrane Central Register of Controlled Trials数据库中进行全面检索。最小样本量为5例用诱导膜技术治疗感染性骨缺损患者的研究被纳入。对个体患者资料进行logistic回归分析,确定与骨不连、感染复发和其他手术相关的因素。结果:筛选后纳入44项研究,1079例患者,1083段感染骨缺损采用诱导膜技术治疗。平均缺陷尺寸为6.8 cm(0.5 ~ 30)。二期手术后,85%(797/942)节段愈合,92%(999/ 1083)节段最终愈合。对296例患者数据的多变量分析表明,年龄越大,骨不连风险越高。在第二阶段采用外固定的患者发生骨不连的风险明显更高,增加了对额外手术的需求。从股骨扩孔器-冲洗器-吸引器中取出的自体移植物增加了不愈合、感染复发和额外的手术率。结论:诱导膜技术是治疗感染性骨缺损的有效技术。第二阶段的内固定可以有效地促进骨愈合,减少额外的手术,而不会增加感染复发。未来的研究应前瞻性地标准化个体患者数据,以促进对受影响患者结果的研究。