Masquelet's induced membrane technique: Review of current concepts and future directions.
Masquelet's induced membrane technique: Review of current concepts and future directions.
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DOI：
10.1002/jor.24978
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
McBride-Gagyi S
中科院分区：
文献类型：
--
作者：
Alford AI;Nicolaou D;Hake M;McBride-Gagyi S
Masquelet的诱导膜技术（MIMT）是一种相对较新的，两个阶段的外科手术，以重建节段性骨缺损。MIMT在20世纪80年代中期首次由Masquelet博士进行，已经显示出极大的希望来彻底改变关键尺寸的骨缺损修复，并且与其替代方法牵张成骨（DO）相比具有几个优势。此外，它在极具挑战性的病例（缺损> 15 cm）中的成功表明，它的研究可能会导致发现新的生物学机制，这些机制可能在节段性缺损愈合和骨折不愈合中发挥作用。在过去的几十年里，MIMT相对于DO的优势导致了MIMT手术在世界范围内的增加。然而，MIMT通常需要重复，因此成人的平均初始成功率明显落后于DO（分别为86%和95%）。在第一阶段期间由免疫系统对聚甲基丙烯酸甲酯（PMMA）骨水泥间隔器的反应产生的自体异物膜对于支持在第二阶段植入的颗粒骨移植物至关重要。然而，膜支持移植骨愈合的生物学和/或物理机制尚不清楚。这种知识的缺乏使得通过技术改进和患者选择来改进MIMT和提高成功率成为一个重大挑战，并阻碍了更广泛的采用。在这篇综述中，总结了基础，转化和临床研究的现有知识。这两个阶段的动力学在正常条件下，以及与药物或材料扰动讨论沿着高优先级的未来研究方向的观点。
Masquelet’s induced membrane technique (MIMT) is a relatively new, two-stage surgical procedure to reconstruct segmental bone defects. First performed by Dr. Masquelet in the mid-1980s, MIMT has shown great promise to revolutionize critical-sized bone defect repair and has several advantages over its alternative, distraction osteogenesis (DO). Also, its success in extremely challenging cases (defects >15cm) suggests that its study could lead to discovery of novel biological mechanisms that might be at play during segmental defect healing and fracture non-union. MIMT’s advantages over DO have led to a world-wide increase in MIMT procedures over the past decades. However, MIMT often needs to be repeated and so the average initial success rate in adults lags significantly behind that of DO (86% vs 95%, respectively). The autologous foreign-body membrane created during the first stage by the immune system’s response to a polymethyl methacrylate (PMMA) bone cement spacer is critical to supporting the morselized bone graft implanted in the second stage. However, the biological and/or physical mechanisms by which the membrane supports graft to bone union are unclear. This lack of knowledge makes refining MIMT and improving the success rates through technique improvements and patient selection a significant challenge and hinders wider adoption. In this review, current knowledge from basic, translational, and clinical studies is summarized. The dynamics of both stages under normal conditions as well as with drug or material perturbations is discussed along with perspectives on high-priority future research directions.
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影响因子：
2.3
作者：
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