Induced membrane technique versus one-stage autografting in management of atrophic nonunion of long bone in the lower limb: clinical and health burden outcomes

作者全名："Zhang, Hu; Fu, Jingshu; Jie, Shen; Wang, Xiaohua; Wang, Shulin; Wu, Hongri; Hu, Yongjun; Huang, Chunji"

作者地址："[Zhang, Hu; Huang, Chunji] Army Med Univ, Mil Med Univ 3, Gaotanyan St 30, Chongqing 400038, Peoples R China; [Fu, Jingshu; Hu, Yongjun] Chongqing Med Univ, Banan Hosp, Longzhouwan St 659, Chongqing 400038, Peoples R China; [Jie, Shen; Wang, Xiaohua; Wang, Shulin; Wu, Hongri] Army Med Univ, Mil Med Univ 3, Southwest Hosp, Dept Orthopaed, 29 Gaotanyan St, Chongqing 400038, Peoples R China; [Wu, Hongri] Naval Med Univ, Navy Hosp 905, Dept Orthoped, Shanghai, Peoples R China"

通信作者："Huang, CJ (通讯作者)，Army Med Univ, Mil Med Univ 3, Gaotanyan St 30, Chongqing 400038, Peoples R China.; Hu, YJ (通讯作者)，Chongqing Med Univ, Banan Hosp, Longzhouwan St 659, Chongqing 400038, Peoples R China.; Wu, HR (通讯作者)，Army Med Univ, Mil Med Univ 3, Southwest Hosp, Dept Orthopaed, 29 Gaotanyan St, Chongqing 400038, Peoples R China.; Wu, HR (通讯作者)，Naval Med Univ, Navy Hosp 905, Dept Orthoped, Shanghai, Peoples R China."

来源：JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001103118000001

JCR分区：Q1

影响因子：2.8

年份：2023

卷号：18

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Nonunion; Induced membrane technique; Autologous bone grafting; Diamond concept

摘要："Objective In this study, we aimed to compare the outcomes of the two-stage induced membrane technique (IMT) and one-stage autografting in the treatment of aseptic atrophic nonunion in lower limb long bones. Methods From January 2014 to January 2022, we reviewed all surgically treated long bone nonunion patients, including patients aged 18 years or older with atrophic nonunion, who were either treated with the two-stage induced membrane technique (IMT) or one-stage autografting. Outcome parameters interns of clinical, quality of life and healthcare burden were recorded and retrospectively analysed between the two treatment populations. The follow-up time was at least 1 year. Results In total, 103 patients who met the criteria for aseptic atrophic nonunion were enrolled. Among them, 41 (39.8%) patients were treated with two-stage IMT, and 62 (60.2%) patients were treated with one-stage autologous bone grafting. The follow-up time was 12 to 68 months, with an average of 28.4 months. The bone healing rate was comparable in both groups (IMT: 92.7% vs. one-stage grafting: 91.9%, P = 0.089) at 12 months post-operation, and the bone healing Lane-Sandhu score was superior in the IMT group (mean: 8.68 vs. 7.81, P = 0.002). Meanwhile, the SF-12 scores of subjective physical component score (PCS) (mean: 21.36 vs. 49.64, P < 0.01) and mental health component score (MCS) (mean: 24.85 vs. 46.14, P < 0.01) significantly increased in the IMT group, as well as in the one-stage grafting group, and no statistically significant difference was found within groups. However, the total hospital stays (median: 8 days vs. 14 days, P < 0.01) and direct medical healthcare costs (median: yen 30,432 vs. yen 56,327, P < 0.05) were greater in the IMT group, while the complications (nonunion 8, infection 3, material failure 2, and donor site pain 6) were not significantly different between the two groups (17.1% vs. 19.4, P = 0.770). Conclusion The data indicate that two-stage method of IMT serves as an alternative method in treating atrophic nonunion; however, it may not be a preferred option, in comprehensive considering patient clinical outcomes and healthcare burden. More evidence-based research is needed to further guide clinical decision-making."

基金机构："Chongqing Natural Science Foundation Program [cstc2021jcyj-msxmX0541, CSTB2023NSCQ-BHX0202]; National Natural Science Foundation Program [82202707]"

基金资助正文："The authors disclose receipt of the following financial or material support for the research, authorship, and/or publication of this article: this work was supported by the Chongqing Natural Science Foundation Program (cstc2021jcyj-msxmX0541, CSTB2023NSCQ-BHX0202) and the National Natural Science Foundation Program (No. 82202707). The author thanks all the participants in this study."