诱导膜技术治疗感染性骨不连的优势与问题

Advantages and problems of induced membrane technology in the treatment of infectious nonunion

背景:感染性骨不连病程常常迁延难愈且有高复发风险,给患者生活带来了极大的困扰。随着对诱导膜技术的不断研究,诱导膜技术治疗感染性骨不连的优势逐渐显露,成为医疗工作新的研究方向。目的:探讨诱导膜技术治疗感染性骨不连的作用机制。方法:检索PubMed、MEDLINE、万方数据库、中国知网、维普及中国生物医学文献数据库2013至2019年相关国内外文献,中文检索词为"诱导膜技术,感染性骨不连,诱导膜,生长因子";英文检索词:"induced membrane technique,infectious Nonunion,induced membrane,growth factor"。结果与结论:诱导膜的生物结构及功能与骨膜相仿,可以诱导骨干细胞形成成骨细胞,进而促进骨组织生长。诱导膜可分泌丰富的血管内皮生长因子、骨形态发生蛋白2、转化生长因子β1等多种生长因子。诱导膜技术应用于临床特别是骨折领域已经取得了显著疗效,为治疗感染性骨不连提供了一种新的选择,而探索最合适的填塞物原料与植骨时间及两者的动态比例成为该项技术的突破点及挑战。

BACKGROUND: The course of infectious bone nonunion is often difficult to heal and has a high risk of recurrence, which brings great trouble to patients’ lives. With the continuous research on the induced membrane technique, the advantages of the treatment of infectious nonunion with the induced membrane technique have gradually emerged and become a new research direction of medical work.OBJECTIVE: To explore the action mechanism of induced membrane technology in the treatment of infectious nonunion.METHODS: The relevant domestic and foreign literatures from 2013 to 2019 of PubMed, MEDLINE, Wanfang, CNKI, VIP, and Ubiquitous Chinese Biomedical Literature Database were retrieved. The key words were "induced membrane technique, infectious nonunion, induced membrane, growth factor" in Chinese and English. RESULTS AND CONCLUSION: The biological structure and function of the induced membrane are similar to that of the periosteum. It can induce the formation of osteoblasts and promote the growth of bone tissue. The induced membrane can secrete many kinds of growth factors, such as vascular endothelial growth factor, bone morphogenetic protein 2 and transforming growth factor β1. The application of induced membrane technology in clinic, especially in the field of fracture, has achieved remarkable results, which provides a new choice for the treatment of infectious nonunion. Exploring the most suitable stuffing material and bone grafting time and the dynamic ratio of the two have become the breakthrough point and challenge of this technology.