Introduction

Masquelet's induced membrane technique offers a definitive contribution to the treatment of diaphyseal osteomyelitis. To overcome its drawbacks while maintaining its principles, technical modifications have been proposed: antibiotic cement, femoral intramedullary autograft harvested by RIA (Reamer Irrigation Aspiration) and interlocking nails.

Material and method

This retrospective study gathered patients with chronic osteomyelitis of the femur or tibia. The first surgical stage consisted of bone resection in the healthy zone and use of a gentamicin cement spacer to fill the bone defect. The second stage consisted of the placement of a statically locked intramedullary nail associated with a bone autograft using the RIA technique.

Results

Among this group of 12 men with diaphyseal osteomyelitis; 9 tibial and 2 femoral, and 1 knee nonunion, the mean bone defect was 7.3 cm (± 6.7). The mean time between the 2 stages was 2.7 months (± 3) with a mean antibiotic period of 3.25 weeks (± 3). There was a femoral diaphyseal fracture at the donor site, and a wrong trajectory intraoperatively during the RIA. Two patients with tibial nonunion presented with nail rupture without septic recurrence. A septic recurrence was healed by removal of the nail. At a minimum follow-up of 18 months, with an average of 5 years, consolidation was complete without infectious recurrence. Despite the statistical weakness related to the size of the cohort, the resumption of early weight bearing (OR = −7.68 95% CI [−13.33 to −2.08] (p = 0.01)) and nail dynamization seemed to have an impact on the formation of complete consolidation (OR = −0.86 95% CI [−1.39 to −0.33] (p = 0.007)).

Discussion and conclusion

This short series, compared to the literature, demonstrated that the proposed technical modifications improved the overall management of this rare and challenging condition while maintaining the reliability of the original technique. Dynamization was also seen to be of particular interest.

Level of evidence

IV, retrospective study.

中文翻译：

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Masquelet 诱导膜技术联合铰刀冲洗抽吸移植和髓内钉 (MaRIAN) 治疗下肢慢性骨干骨髓炎

介绍

Masquelet 的诱导膜技术为骨干骨髓炎的治疗做出了决定性的贡献。为了在保持其原则的同时克服其缺点，提出了技术修改：抗生素骨水泥、通过 RIA（铰刀灌注抽吸）收获的股骨髓内自体移植物和互锁钉。

材料与方法

这项回顾性研究收集了患有股骨或胫骨慢性骨髓炎的患者。第一手术阶段包括健康区的骨切除和使用庆大霉素骨水泥间隔物填充骨缺损。第二阶段包括使用 RIA 技术放置与自体骨移植相关的静态锁定髓内钉。

结果

在这组 12 名患有骨干骨髓炎的男性中；9 例胫骨和 2 例股骨，1 例膝关节骨不连，平均骨缺损为 7.3  cm (±  6.7)。两个阶段之间的平均时间为 2.7 个月 (±  3)，平均抗生素治疗时间为 3.25 周 (±  3)。供体部位存在股骨骨干骨折，RIA 术中轨迹错误。两名胫骨骨不连患者出现指甲破裂，但没有脓毒症复发。通过去除指甲治愈了化脓性复发。在至少 18 个月（平均 5 年）的随访中，巩固完成，没有感染复发。尽管与队列规模相关的统计学弱点，恢复早期负重（或 =  −7.68 95% CI [−13.33 to −2.08] ( p  =  0.01)) 和钉动力化似乎对完全巩固的形成有影响 (OR  =  −0.86 95% CI [−1.39 to −0.33] ( p  =  0.007))。

讨论与结论

与文献相比，这个简短的系列表明，拟议的技术修改改善了这种罕见且具有挑战性的情况的整体管理，同时保持了原始技术的可靠性。动态化也被视为特别令人感兴趣。

证据等级

四、回顾性研究。