Membrane induction combined with bilateral bone transport for treatment of large-segment infected bone defect in tibia

HU Bi-jun; HAN Pei; ZUO Zhen-hua; XU Zheng-yu

doi:10.3969/j.issn.2095-252X.2025.03.002

Abstract：Objective To explore the therapeutic effect of membrane induction combined with bidirectional bone transport in the treatment of tibial large-segment infected bone defects.Methods A retrospective analysis of the clinical data of 20 patients with large-segment infected tibial bone defects who were treated with the induced membrane technique combined with bidirectional bone transport in our department from January 2018 to December 2022,including 15 males and 5 females,with a mean age of(42.5±12.8)years(range:22-64 years).Following a thorough debridement,the length of bone defects ranged from 6 to 14 cm,with a mean of(9.5±2.3)cm.Prior to this treatment regimen,all patients underwent 2 to 5 operations,with an average of 3.5 operations.In this study,we used a three-stage treatment regimen,including debridement,external fixation,and antibiotic-impregnated cement filling in the first stage,proximal and distal tibial osteotomies with bone transport in the second stage,and management of the docking site in the third stage.The results of the final follow-up were evaluated using Association for the Study of and Application of the Methods of Ilizarov(ASAMI)bone healing and functional evaluation criteria.Results All patients were followed up for 12 to 30 months after external fixator removal,with an average of(18.0±4.9)months.All bone defects healed well.Bone transport time ranged from 45 to 90 days,with an average of(62.5±13.4)days;consolidation time of the bone elongation zone ranged from 7 to 18 months,with an average of(11.3±2.8)months;the mean docking site healing time was 7.5 months(range:6.0-8.8 months);the mean external fixation time was 12 months(range:10.0-14.8 months);and the mean external fixation index was 1.28 months/cm(range:1.25-1.35 months/cm).According to ASAMI criteria,17 cases achieved excellent bone union and 3 cases achieved good union;16 cases achieved excellent functional outcomes and 4 cases achieved good outcomes.In this group,7 cases of pin track infection,6 cases of skin entrapment,and 4 cases of axial displacement were observed.Conclusions Membrane induction technique combined with bidirectional bone transport is effective in treating tibial large-segment infected bone defects.It enables thorough eradication of infection,reconstruction of bone defects and shortening of external fixation time,demonstrating safety and favorable efficacy.