Defectos óseos segmentarios infectados en huesos largos: tratamiento con técnica de Masquelet.[Masquelet technique for the treatment of infected segmental long-bone defects]
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Publicado:
feb 20, 2019
Palabras clave:
Defecto óseo segmentario, defecto óseo infectado, fémur, tibia, técnica de Masquelet, segmental bone defect, infected bone defect, femur, Masquelet technique
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Resumen
Introducción: Los defectos óseos segmentarios infectados son entidades de complejo tratamiento. La técnica de Masquelet representa una alternativa para estos casos. El objetivo de este estudio retrospectivo, multicéntrico fue mostrar los resultados clínicos y radiológicos obtenidos con esta técnica de reconstrucción en defectos óseos segmentarios infectados de fémur y tibia, caracterizar los defectos tratados y describir los diferentes aspectos de la técnica quirúrgica.Materiales y Métodos: Analizamos a 24 pacientes (14 hombres y 10 mujeres; edad promedio 36.16 años [rango 18-67]) tratados con la técnica de Masquelet, operados entre 2011 y 2016. El seguimiento promedio fue de 16.5 meses (rango 12-27) desde el segundo tiempo quirúrgico. Se analizaron el hueso afectado, la longitud del defecto (en cm), el tiempo de consolidación y el control del proceso infeccioso.Resultados: La longitud del defecto óseo tratado fue, en promedio, de 5,7 cm (rango 3-12), fue superior a 4 cm en el 50% de los casos, el defecto óseo segmentario de mayor tamaño en la tibia fue de 12 cm y de 10 cm en el fémur. Se logró la consolidación ósea en todos los casos, en 4.5 meses. Un paciente presentó una recidiva del proceso infeccioso a los 12 meses de la consolidación.Conclusiones: La técnica de Masquelet o de la membrana inducida ofrece una alternativa razonable y sencilla para un problema altamente desafiante como son los defectos óseos segmentario infectados. La tasa de consolidación es superior al 90% aun en casos complejos. ABSTRACTIntroduction: Infected segmental bone defects are challenging conditions which require a complex treatment. The Masquelet technique is an alternative for these cases. The aim of this retrospective, multicenter study was to show the clinical and radiological outcomes achieved with the use of this reconstruction technique in infected femoral and tibial segmental defects in order to characterize the defects treated and describe different aspects of this surgical approach.Methods: We analyzed 24 patients (14 men and 10 women; average age 36.16 years [range 18-67]) treated with the Masquelet technique between 2011 and 2016. The average follow-up was 16.5 months (range 12-27) from the second surgical stage. We analyzed the affected bone, defect length (cm), consolidation time and infection control.Results: Average length of treated bone defect was 5.7 cm (range 3-12), exceeding 4 cm in 50% of the cases. The largest segmental bone defect was 12 cm at the tibia and 10 cm at the femur. Bone consolidation was achieved in all cases, on an average of 4.5 months. One patient presented a recurrent infection 12 months after successful consolidation.Conclusions: The Masquelet technique, or induced membrane technique, offers a reasonable and simple alternative to a highly challenging problem, such as infected segmental bone defects, achieving a consolidation rate greater than 90% even in complex cases.
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Garabano, G., Pesciallo, C., Montero Vinces, A., Gómez, D. J., Bidolegui, F., & Casteulani, A. C. (2019). Defectos óseos segmentarios infectados en huesos largos: tratamiento con técnica de Masquelet.[Masquelet technique for the treatment of infected segmental long-bone defects]. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(1), 15-26. https://doi.org/10.15417/issn.1852-7434.2019.84.1.853
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Investigación Clínica
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1. Ronga M, Ferraro S, Fagetti A, Cherubino M, Valdatta L, Cherubino P. Masquelet technique for the treatment of a severe acute tibial bone loss. Injury 2014;45:111-5. https://doi.org/10.1016/j.injury.2014.10.033
2. DeCoster TA, Gehlert RJ, Mikola EA, Pirela-Cruz MA. Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg 2004;12:28-38. https://insights.ovid.com/pubmed?pmid=14753795
3. Obremskey WT, Molina CS, Collinge C, Tornetta P, Sagi C, Schmidt A, et al. Current practice in the management of segmental bone defects among orthopaedic trauma surgeons. J Orthop Trauma 2013;28:203-7. DOI: 10.1097/BOT.0000000000000034
4. Giannoudis PV, Faour O, Goff T, Kanakaris N, Dimitriou R. Masquelet technique for the treatment of bone defects:
Tips-tricks and future directions. Injury 2011;42:591-8. DOI: 10.1016/j.injury.2011.03.036
5. Taylor BC, French BG, Fowler TT, Russell J, Poka A. Induced membrane technique for reconstruction to manage bone loss. J Am Acad Orthop Surg 2012;20:142-50. DOI: 10.5435/JAAOS-20-03 142
6. Mitchell SE, Keating JF, Robinson CM. The treatment of open femoral fractures with bone loss. J Bone Joint Surg Br 2010;92:1678-84. DOI: 10.1302/0301-620X.92B12.25190
7. Gaskill TR, Urbaniak JR, Aldridge JM. Free vascularized fibular transfer for femoral head osteonecrosis: donor and graft site morbidity. J Bone Joint Surg Am 2009;91:861-7. DOI: 10.2106/JBJS.H.01105
8. Myeroff C, Archdeancon M. Autogenous bone graft: donor sites and techniques. J Bone Joint Surg Am 2011;93:222-7. DOI: 10.2106/JBJS.J.01513
9. Khan SN, Cammisa FP, Jr, Sandhu HS, Diwan AD, Girardi FP, Lane JM. The biology of bone grafts. J Am Acad Orthop Surg 2003;26:923-4. DOI: 10.5435/00124635-200501000-00010
10. Cattaneo R, Catagni M, Johnson EE. The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clin Orthop Relat Res 1992;280:143-52. DOI: 10.1097/00003086-199207000-00017
11. Pelissier P, Casoli V, Demiri E, Martin D, Baudet J. Soleus-fibula free transfer in lower limb reconstruction. Plast Reconstr Surg 2000;105:567-73. DOI:10.1097/00006534-200002000-00014
12. Masquelet AC, Fitoussi F, Begue T, Muller GP. [Reconstruction of the long bones by the induced membrane and spongy autograft]. Ann Chir Plast Esthet 2000;45:346-53.
13. Micev AJ, Kalainov DM, Soneru AP. Masquelet technique for treatment of segmental bone loss in the upper extremity. J Hand Surg Am 2015;40:593-8. DOI: 10.1016/j.jhsa.2014.12.007
14. Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res 2012;98:97-102. DOI: 10.1016/j.otsr.2011.11.001
15. Pelissier P, Masquelet AC, Bareille R, Mathoulin Pelissier S, Amedee J. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res 2004;22:73-9. DOI: 10.1016/S0736-0266(03)00165-7
16. Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 2010;41:27-37. DOI: 10.1016/j.ocl.2009.07.011
17. Stafford PR, Norris BL. Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: A review of 25 cases. Injury 2010;41:S72-7. DOI: 10.1016/S0020-1383(10)70014-0
18. Bosemark P, Perdikouri C, Pelkonen M, Isaksson H, Tägil M. The Masquelet induced membrane technique with BMP and a synthetic scaffold can heal a rat femoral critical size defect. J Orthop Res 2015;33:488-95. DOI: 10.1002/jor.22815
19. Biau DJ, Pannier S, Masquelet AC, Glorion C. Case report: Reconstruction of a 16-cm diaphyseal defect after ewing’s resection in a child. Clin Orthop Relat Res 2009;467:572-7. DOI: 10.1007/s11999-008-0605-9
20. Fitoussi F, Ilharreborde B. Is the induced-membrane technique successful for limb reconstruction after resecting large bone tumors in children? Clin Orthop Relat Res 2015;473(6):2067-75. DOI: 10.1007/s11999-015-4164-6
21. Amouyel T, Deroussen F, Plancq M-C, Collet L-M, Gouron R. Successful treatment of humeral giant aneurysmal bone cyst: value of the induced membrane reconstruction technique. J Shoulder Elb Surg 2014;23:212-6. DOI: 10.1016/j.jse.2014.05.028
22. Gouron R, Deroussen F, Plancq MC, Collet LM. Bone defect reconstruction in children using the induced membrane technique: A series of 14 cases. Orthop Traumatol Surg Res 2013;99:837-43. DOI: 10.1016/j.otsr.2013.05.005
23. Aho OM, Lehenkari P, Ristiniemi J, Lehtonen S, Risteli J, Leskelä HV. The mechanism of action of induced membranes in bone repair. J Bone Joint Surg Am 2013;95:597-604. DOI: 10.2106/JBJS.L.00310
24. Ren L, Kang Y, Browne C, Bishop J, Yang Y. Fabrication, vascularization and osteogenic properties of a novel synthetic biomimetic induced membrane for the treatment of large bone defects. Bone 2014;64:173-82. DOI: 10.1016/j.bone.2014.04.011
25. Viateau V, Guillemin G, Yang YC, Bensaïd W, Reviron T, Oudina K, et al. A technique for creating criticalsize defects in the metatarsus of sheep for use in investigation of healing of long-bone defects. Am J Vet Res 2004;65:1653-7. DOI: 10.2460/ajvr.2004.65.1653
26. Wong TM, Lau TW, Li X, Fang C, Yeung K, Leung F. Masquelet technique for treatment of posttraumatic bone defects. Sci World J 2014;2014:1-5. DOI: 10.1155/2014/710302. eCollection 2014
27. Woon CY-L, Chong K-W, Wong M-K. Induced membranes—A staged technique of bone-grafting for segmental bone loss. A report of two cases and a literature review. J Bone Joint Surg Am 2010;92:196-201. DOI: 10.2106/JBJS.I.00273
28. Joseph TN, Chen AL, Di Cesare PE, Cesare PE Di, Lindskog DM, Baumgaertner MR. Use of antibioticimpregnated cement in total joint arthroplasty unstable intertrochanteric hip fractures in the elderly. J Am Acad Orthop Surg 2003;11:38-47. DOI: 10.5435/00124635-200301000-00006
29. Jaeblon T. Polymethylmethacrylate: properties and contemporary uses in orthopaedics. J Am Acad Orthop Surg
2010;18(5):297-305. DOI: 10.5435/00124635-201005000-00006
30. Kuehn K-D, Ege W, Gopp U. Acrylic bone cements: mechanical and physical properties. Orthop Clin North Am 2005;36:29-39. DOI: 10.1016/j.ocl.2004.06.011
31. Hsieh P-H, Shih C-H, Chang Y-H, Lee MS, Shih H-N, Yang W-E. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am 2004;86(9):1989-97. https://insights.ovid.com/pubmed?pmid=15342762
32. Masquelet AC, Obert L. La technique de la membrane induite pour les pertes de substance osseuse de la main et du poignet. Chir Main 2010;29:221-4. DOI: 10.1016/j.main.2010.10.007
33. Viateau V, Guillemin G, Calando Y, Logeart D, Oudina K, Sedel L, et al. Induction of a barrier membrane to facilitate reconstruction of massive segmental diaphyseal bone defects: An ovine model. Vet Surg 2006;35:445-52. DOI: 10.1111/j.1532-950X.2006.00173.x
34. Viateau V, Guillemin G, Bousson V, Oudina K, Hannouche D, Sedel L, et al. Long-bone critical-size defects treated with tissue-engineered grafts: A study on sheep. J Orthop Res 2007;25(6):741-9. DOI: 10.1002/jor.20352
35. Donegan DJ, Scolaro J, Matuszewski PE, Mehta S. Staged bone grafting following placement of an antibiotic spacer block for the management of segmental long bone defects. Orthopedics 2011;19104:730-5. DOI: 10.3928/01477447-20110922-16
36. McCall TA, Brokaw DS, Jelen BA, Scheid DK, Scharfenberger AV, Maar DC, et al. Treatment of large segmental bone defects with reamer-irrigator-aspirator bone graft: technique and case series. Orthop Clin North Am 2010;41(1):63-73. DOI: 10.1016/j.ocl.2009.08.002
37. Apard T, Bigorre N, Cronier P, Duteille F, Bizot P, Massin P. Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing. Orthop Traumatol Surg Res 2010;96(5):549-53. DOI: 10.1016/j.otsr.2010.02.010
2. DeCoster TA, Gehlert RJ, Mikola EA, Pirela-Cruz MA. Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg 2004;12:28-38. https://insights.ovid.com/pubmed?pmid=14753795
3. Obremskey WT, Molina CS, Collinge C, Tornetta P, Sagi C, Schmidt A, et al. Current practice in the management of segmental bone defects among orthopaedic trauma surgeons. J Orthop Trauma 2013;28:203-7. DOI: 10.1097/BOT.0000000000000034
4. Giannoudis PV, Faour O, Goff T, Kanakaris N, Dimitriou R. Masquelet technique for the treatment of bone defects:
Tips-tricks and future directions. Injury 2011;42:591-8. DOI: 10.1016/j.injury.2011.03.036
5. Taylor BC, French BG, Fowler TT, Russell J, Poka A. Induced membrane technique for reconstruction to manage bone loss. J Am Acad Orthop Surg 2012;20:142-50. DOI: 10.5435/JAAOS-20-03 142
6. Mitchell SE, Keating JF, Robinson CM. The treatment of open femoral fractures with bone loss. J Bone Joint Surg Br 2010;92:1678-84. DOI: 10.1302/0301-620X.92B12.25190
7. Gaskill TR, Urbaniak JR, Aldridge JM. Free vascularized fibular transfer for femoral head osteonecrosis: donor and graft site morbidity. J Bone Joint Surg Am 2009;91:861-7. DOI: 10.2106/JBJS.H.01105
8. Myeroff C, Archdeancon M. Autogenous bone graft: donor sites and techniques. J Bone Joint Surg Am 2011;93:222-7. DOI: 10.2106/JBJS.J.01513
9. Khan SN, Cammisa FP, Jr, Sandhu HS, Diwan AD, Girardi FP, Lane JM. The biology of bone grafts. J Am Acad Orthop Surg 2003;26:923-4. DOI: 10.5435/00124635-200501000-00010
10. Cattaneo R, Catagni M, Johnson EE. The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clin Orthop Relat Res 1992;280:143-52. DOI: 10.1097/00003086-199207000-00017
11. Pelissier P, Casoli V, Demiri E, Martin D, Baudet J. Soleus-fibula free transfer in lower limb reconstruction. Plast Reconstr Surg 2000;105:567-73. DOI:10.1097/00006534-200002000-00014
12. Masquelet AC, Fitoussi F, Begue T, Muller GP. [Reconstruction of the long bones by the induced membrane and spongy autograft]. Ann Chir Plast Esthet 2000;45:346-53.
13. Micev AJ, Kalainov DM, Soneru AP. Masquelet technique for treatment of segmental bone loss in the upper extremity. J Hand Surg Am 2015;40:593-8. DOI: 10.1016/j.jhsa.2014.12.007
14. Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res 2012;98:97-102. DOI: 10.1016/j.otsr.2011.11.001
15. Pelissier P, Masquelet AC, Bareille R, Mathoulin Pelissier S, Amedee J. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res 2004;22:73-9. DOI: 10.1016/S0736-0266(03)00165-7
16. Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 2010;41:27-37. DOI: 10.1016/j.ocl.2009.07.011
17. Stafford PR, Norris BL. Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: A review of 25 cases. Injury 2010;41:S72-7. DOI: 10.1016/S0020-1383(10)70014-0
18. Bosemark P, Perdikouri C, Pelkonen M, Isaksson H, Tägil M. The Masquelet induced membrane technique with BMP and a synthetic scaffold can heal a rat femoral critical size defect. J Orthop Res 2015;33:488-95. DOI: 10.1002/jor.22815
19. Biau DJ, Pannier S, Masquelet AC, Glorion C. Case report: Reconstruction of a 16-cm diaphyseal defect after ewing’s resection in a child. Clin Orthop Relat Res 2009;467:572-7. DOI: 10.1007/s11999-008-0605-9
20. Fitoussi F, Ilharreborde B. Is the induced-membrane technique successful for limb reconstruction after resecting large bone tumors in children? Clin Orthop Relat Res 2015;473(6):2067-75. DOI: 10.1007/s11999-015-4164-6
21. Amouyel T, Deroussen F, Plancq M-C, Collet L-M, Gouron R. Successful treatment of humeral giant aneurysmal bone cyst: value of the induced membrane reconstruction technique. J Shoulder Elb Surg 2014;23:212-6. DOI: 10.1016/j.jse.2014.05.028
22. Gouron R, Deroussen F, Plancq MC, Collet LM. Bone defect reconstruction in children using the induced membrane technique: A series of 14 cases. Orthop Traumatol Surg Res 2013;99:837-43. DOI: 10.1016/j.otsr.2013.05.005
23. Aho OM, Lehenkari P, Ristiniemi J, Lehtonen S, Risteli J, Leskelä HV. The mechanism of action of induced membranes in bone repair. J Bone Joint Surg Am 2013;95:597-604. DOI: 10.2106/JBJS.L.00310
24. Ren L, Kang Y, Browne C, Bishop J, Yang Y. Fabrication, vascularization and osteogenic properties of a novel synthetic biomimetic induced membrane for the treatment of large bone defects. Bone 2014;64:173-82. DOI: 10.1016/j.bone.2014.04.011
25. Viateau V, Guillemin G, Yang YC, Bensaïd W, Reviron T, Oudina K, et al. A technique for creating criticalsize defects in the metatarsus of sheep for use in investigation of healing of long-bone defects. Am J Vet Res 2004;65:1653-7. DOI: 10.2460/ajvr.2004.65.1653
26. Wong TM, Lau TW, Li X, Fang C, Yeung K, Leung F. Masquelet technique for treatment of posttraumatic bone defects. Sci World J 2014;2014:1-5. DOI: 10.1155/2014/710302. eCollection 2014
27. Woon CY-L, Chong K-W, Wong M-K. Induced membranes—A staged technique of bone-grafting for segmental bone loss. A report of two cases and a literature review. J Bone Joint Surg Am 2010;92:196-201. DOI: 10.2106/JBJS.I.00273
28. Joseph TN, Chen AL, Di Cesare PE, Cesare PE Di, Lindskog DM, Baumgaertner MR. Use of antibioticimpregnated cement in total joint arthroplasty unstable intertrochanteric hip fractures in the elderly. J Am Acad Orthop Surg 2003;11:38-47. DOI: 10.5435/00124635-200301000-00006
29. Jaeblon T. Polymethylmethacrylate: properties and contemporary uses in orthopaedics. J Am Acad Orthop Surg
2010;18(5):297-305. DOI: 10.5435/00124635-201005000-00006
30. Kuehn K-D, Ege W, Gopp U. Acrylic bone cements: mechanical and physical properties. Orthop Clin North Am 2005;36:29-39. DOI: 10.1016/j.ocl.2004.06.011
31. Hsieh P-H, Shih C-H, Chang Y-H, Lee MS, Shih H-N, Yang W-E. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am 2004;86(9):1989-97. https://insights.ovid.com/pubmed?pmid=15342762
32. Masquelet AC, Obert L. La technique de la membrane induite pour les pertes de substance osseuse de la main et du poignet. Chir Main 2010;29:221-4. DOI: 10.1016/j.main.2010.10.007
33. Viateau V, Guillemin G, Calando Y, Logeart D, Oudina K, Sedel L, et al. Induction of a barrier membrane to facilitate reconstruction of massive segmental diaphyseal bone defects: An ovine model. Vet Surg 2006;35:445-52. DOI: 10.1111/j.1532-950X.2006.00173.x
34. Viateau V, Guillemin G, Bousson V, Oudina K, Hannouche D, Sedel L, et al. Long-bone critical-size defects treated with tissue-engineered grafts: A study on sheep. J Orthop Res 2007;25(6):741-9. DOI: 10.1002/jor.20352
35. Donegan DJ, Scolaro J, Matuszewski PE, Mehta S. Staged bone grafting following placement of an antibiotic spacer block for the management of segmental long bone defects. Orthopedics 2011;19104:730-5. DOI: 10.3928/01477447-20110922-16
36. McCall TA, Brokaw DS, Jelen BA, Scheid DK, Scharfenberger AV, Maar DC, et al. Treatment of large segmental bone defects with reamer-irrigator-aspirator bone graft: technique and case series. Orthop Clin North Am 2010;41(1):63-73. DOI: 10.1016/j.ocl.2009.08.002
37. Apard T, Bigorre N, Cronier P, Duteille F, Bizot P, Massin P. Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing. Orthop Traumatol Surg Res 2010;96(5):549-53. DOI: 10.1016/j.otsr.2010.02.010