影响骨缺损Masquelet治疗诱导膜血管形成的因素△（开放获取）

Factors related to membrane angiogenesis induced by Masquelet technique for bone defect

摘要:

[目的]探讨影响 Masquelet 重建手术中诱导膜血管形成的相关因素。[方法]2019 年 8 月—2021 年 10 月采用 Mas- quelet 技术治疗的 36 例骨缺损患者纳入本研究，观察诱导膜组织血管形成和分布情况，采用单因素比较和多因素分析探讨影响诱导膜血管形成的相关因素。[结果]36 例患者均顺利完成一期手术，二期手术取诱导膜组织切片血管计数，根据诱导膜组织切片血管计数的中位数将患者分为两组，中位数之上纳入良好组，中位数之下纳入不足组，两组各 18 例。单项因素比较表明：良好组患者组织学评估中的膜内成骨数量 [例, 有/无, (4/14) vs (0/18), P=0.021] 显著高于不足组，伤口闭合使用游离皮瓣数量 [例, 行游离皮瓣/未行游离皮瓣, (2/16) vs (7/11), P=0.029] 显著低于不足组，诱导膜血管计数 [条/mm² , (53.4±12.7) vs (21.4±7.1), P＜0.001] 显著多于不足组。两组炎症反应、异物反应、纤维化分级、骨缺损部位、原因、长度，肌肉覆盖情况、清创程度、填充骨水泥情况、一期术后切口愈合等级、骨水泥放置时间或二次手术间隔时间的比较差异均无统计学意义（P＞0.05）。多因素分析结果显示，伤口闭合使用游离皮瓣、诱导膜有膜内成骨是影响诱导膜内血管数量的相关因素，其标准化偏回归系数分别为 -0.350、0.384。[结论] 年龄、性别、BMI、吸烟、饮酒、糖尿病及大部分骨缺损相关资料对诱导膜血管化无影响。诱导膜有膜内成骨、伤口闭合使用游离皮瓣是影响诱导膜内血管数量的相关因素。

Abstract:

[Objective] To investigate the factors related to membrane angiogenesis induced by Masquelet technique. [Methods] A total of 36 patients who had bone defect treated by Masquelet technique were included in this study from August 2019 to October 2021. The formation and distribution blood vessels of induced membrane tissue were observed, and the factors related to induced membrane vascularization were analyzed by univariate comparison and multi-factor regression analysis. [Results] All the 36 patients had the first-stage operation performed successfully, and had histological assay of membrane angiogenesis at the second-stage surgery by biopsy of the membrane tissue. According to the median blood vessel count of the induced membrane tissue section, the patients were divided into two groups, the good group with blood vessel count above the median, whereas the poor group below the median, with 18 cases in each group. As results of univariate comparison, the good group had significantly greater than the poor group in terms of intramembranous bone formation [yes/no, (4/14) vs (0/18), P=0.021] and membrane blood vessel density [(53.4±12.7) vessel/mm² vs (21.4±7.1) vessel/mm² , P＜0.001], whereas the former had significantly lower ratio of wound closure with free skin flap than the latter [flap/non-flap, (2/16) vs (7/11), P=0.029]. However, there were no significant differences in the general information and comorbidities, the inflammatory response, foreign body rejection, fibrosis grade, site cause, length of bone defect, muscle coverage, debridement degree, filling of bone cement, healing grade of first-stage incision, interval between the two stages of surgical operation between the two groups (P＞0.05). Regarding the multiple regression analysis, the wound closure with free flap and intramembranous osteogenesis were the factors related to number of induced intramembranous vessels, with the standardized partial regression coefficients of -0.350 and 0.384, respectively. [Conclusion] Age, sex, BMI, smoking, drinking, diabetes and bone defects had no impact on inducing membrane vascularization, whereas wound closure with free skin flaps and intramembrane osteogenesis are the factors related to the number of blood vessels formation in the induced membrane.