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Induced membrane technique for large bone defects: A systematic review and individual participant data meta-analysis
AIMS: The aim of this study was to evaluate the efficacy of induced membrane technique (IMT), and to analyze the relationships between patient factors and surgical parameters as well as their impacts on achieving bone union and complication rates. MATERIALS AND METHODS: A comprehensive, computerized...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9276340/ https://www.ncbi.nlm.nih.gov/pubmed/35758359 http://dx.doi.org/10.1097/MD.0000000000029292 |
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author | Sun, Shih-Heng Tsai, Wen-Wen Shiu, Sz-Iuan Chen, Chih-Hui |
author_facet | Sun, Shih-Heng Tsai, Wen-Wen Shiu, Sz-Iuan Chen, Chih-Hui |
author_sort | Sun, Shih-Heng |
collection | PubMed |
description | AIMS: The aim of this study was to evaluate the efficacy of induced membrane technique (IMT), and to analyze the relationships between patient factors and surgical parameters as well as their impacts on achieving bone union and complication rates. MATERIALS AND METHODS: A comprehensive, computerized search of PubMed, Embase, and The Cochrane Library was conducted, and articles published from January 1, 1978 to February 1, 2021 were included. Clinical trials matching the following inclusion criteria were included: 1. published as a case series, case-controlled studies, or cohort study; 2. IMT was performed for more than 10 cases within the study. Univariate and multivariate logistic regression were performed with random intercepts to determine the association of specific predictor variables with nonunion rate, postoperative infection, the need for additional procedures, and time to union. RESULTS: Seventy eight trials were included in the study with a total of 3840 patients managed with IMT. Mean age was 38.6 (0.8–88) years, mean size of bone defects was 6.4 (0–25) cm primarily distributed in the tibia (n = 1814, 60.9%), and overall union rate was 87.6%. Multivariate analysis showed the odds of nonunion were significantly increased in patients with an interval between two stages from 8 to 12 weeks and ≥12 weeks. Patients with preoperative infection and addition of antibiotic to bone cement during IMT had significantly decreased odds of longer union time, but preoperative infection caused increased odds of additional surgery. External fixation throughout 2 stages had significantly increased odds of postoperative infection and additional surgery. CONCLUSIONS: We recommend that the timing of the second stage should be delayed until 6 to 8 weeks after the first stage. Bone cement with antibiotics can control the infection rate and shorten the healing time. Furthermore, there is no need to avoid using internal fixation due to possible concerns about causing postoperative infection. |
format | Online Article Text |
id | pubmed-9276340 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-92763402022-07-13 Induced membrane technique for large bone defects: A systematic review and individual participant data meta-analysis Sun, Shih-Heng Tsai, Wen-Wen Shiu, Sz-Iuan Chen, Chih-Hui Medicine (Baltimore) 7100 AIMS: The aim of this study was to evaluate the efficacy of induced membrane technique (IMT), and to analyze the relationships between patient factors and surgical parameters as well as their impacts on achieving bone union and complication rates. MATERIALS AND METHODS: A comprehensive, computerized search of PubMed, Embase, and The Cochrane Library was conducted, and articles published from January 1, 1978 to February 1, 2021 were included. Clinical trials matching the following inclusion criteria were included: 1. published as a case series, case-controlled studies, or cohort study; 2. IMT was performed for more than 10 cases within the study. Univariate and multivariate logistic regression were performed with random intercepts to determine the association of specific predictor variables with nonunion rate, postoperative infection, the need for additional procedures, and time to union. RESULTS: Seventy eight trials were included in the study with a total of 3840 patients managed with IMT. Mean age was 38.6 (0.8–88) years, mean size of bone defects was 6.4 (0–25) cm primarily distributed in the tibia (n = 1814, 60.9%), and overall union rate was 87.6%. Multivariate analysis showed the odds of nonunion were significantly increased in patients with an interval between two stages from 8 to 12 weeks and ≥12 weeks. Patients with preoperative infection and addition of antibiotic to bone cement during IMT had significantly decreased odds of longer union time, but preoperative infection caused increased odds of additional surgery. External fixation throughout 2 stages had significantly increased odds of postoperative infection and additional surgery. CONCLUSIONS: We recommend that the timing of the second stage should be delayed until 6 to 8 weeks after the first stage. Bone cement with antibiotics can control the infection rate and shorten the healing time. Furthermore, there is no need to avoid using internal fixation due to possible concerns about causing postoperative infection. Lippincott Williams & Wilkins 2022-06-24 /pmc/articles/PMC9276340/ /pubmed/35758359 http://dx.doi.org/10.1097/MD.0000000000029292 Text en Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) |
spellingShingle | 7100 Sun, Shih-Heng Tsai, Wen-Wen Shiu, Sz-Iuan Chen, Chih-Hui Induced membrane technique for large bone defects: A systematic review and individual participant data meta-analysis |
title | Induced membrane technique for large bone defects: A systematic review and individual participant data meta-analysis |
title_full | Induced membrane technique for large bone defects: A systematic review and individual participant data meta-analysis |
title_fullStr | Induced membrane technique for large bone defects: A systematic review and individual participant data meta-analysis |
title_full_unstemmed | Induced membrane technique for large bone defects: A systematic review and individual participant data meta-analysis |
title_short | Induced membrane technique for large bone defects: A systematic review and individual participant data meta-analysis |
title_sort | induced membrane technique for large bone defects: a systematic review and individual participant data meta-analysis |
topic | 7100 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9276340/ https://www.ncbi.nlm.nih.gov/pubmed/35758359 http://dx.doi.org/10.1097/MD.0000000000029292 |
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