Resorbable polylactide membrane for the treatment of segmental bone defects |
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| Institution: | 1. Department of Orthopaedic Surgery, Childrens’s Hospital and Medical Center and University of Nebraska Medical Center, Omaha, NE 68114, United States of America;2. Head of Bone and Joint Infection, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Ave, Baltimore, MD 21215, United States of America;1. Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan;2. Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan;3. Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan;4. Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Gunma, Japan;5. Department of Orthopaedic Surgery and Traumatology, Kawasaki Medical School General Medical Center, Okayama, Japan;6. Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan;1. Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, IN, India;2. Interventional Radiology, D.Y. Patil Medical College and Research Centre, Pune, Maharashtra, India;1. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY;2. Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY |
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| Abstract: | IntroductionSegmental bone defects are a challenging clinical problem. In animal studies and craniomaxillofacial surgery, resorbable polylactide membrane (OrthoMesh; DePuy Synthes, West Chester, PA) shows promise for treatment of bone defects. This study presents the results of the treatment of segmental bone defects with resorbable polylactide membrane, bone morphogenic protein-2 (BMP-2), and autograft.MethodsThis study was approved by the institutional review board. All patients with a segmental bone defect treated with a resorbable polylactide membrane by a single surgeon from 2010 to 2019 were retrospectively reviewed. Data related to demographic variables, surgical details, and union were collected.ResultsEleven patients with median age of 37 years (range 22–62 years) were included in the study with segmental bone defects in the tibia (n = 3), femur (n = 4), or forearm (n = 4). Median bone defect size was 6 cm (range 3–12 cm). Etiology of bone defects included osteomyelitis (n = 7), oncologic resection (n = 3), and post-traumatic aseptic nonunion (n = 1). Flap coverage was performed in two patients. Median radiographic follow-up was 24 months (range 5–75 months). Ten patients (10/11) achieved union at a median of 17 months (range 5–46 months). Seven patients required reoperation for any reason with six patients requiring repeat grafting.ConclusionsTo our knowledge, this study is the largest series of patients with segmental bone defects treated with resorbable polylactide membrane. Resorbable polylactide membrane in combination with BMP-2 and autograft represents a safe and effective method of bone graft containment in segmental bone defects measuring up to 12 cm in this series. Ten of 11 patients achieved union at a median time of 16 months with 6 patients requiring repeat grafting. These results compare favorably with the induced membrane technique. This study is limited by its retrospective design, absence of control and comparison groups, and low patient numbers. Future prospective randomized study of the induced membrane technique and resorbable polylactide membrane should be undertaken to determine preferred approaches for treatment of segmental bone defects. |
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