Abstract:
Introduction: The management of segmental long-bone defects is a challenge. The literature has
described many techniques, but each is fraught with specific difficulties. Masquelet’s technique of
induced membrane is now a reference surgical procedure for the treatment of complex lesions requiring
bone regeneration. The concept of induced membrane was introduced by Alain-Charles Masquelet in
1986. The Masquelet method consists in formation of an induced membrane by a foreign body which
has secretory properties, influencing positive on the regeneration and strengthening of the cancellous
bone grafts. Aim: to investigate the morphological properties and characteristics of induced membrane
which was modeled in an experimental group of rabbits in order to asses and to optimize the effectiveness
of the Masquelet method in the clinic.
Materials and methods: Experimental work was done using a group of rabbits (n=10) with the
weight 5,5±0,5kg and the age 5 months. The investigation had 3 steps. The first step of the study
consisted in creating the bone defect, filling it up with an antibiotic-impregnated cement spacer and
stabilizing it with a plate. The second step of the study was 21 days later, consisting in incision of the
induced membrane, removing the spacer and filling up the space with cancellous bone chips collected
from iliac crest. At this stage we sacrificed 5 rabbits in order to perform the histological and
morphological examination. At the sixth week we switched to the third step – ablation of metal
construction and the radiological control exam. At this stage we sacrificed 5 rabbits to study the
morphological aspect of the healed bone.
Results: The histo-morphological examination performed at the 21 days demonstrated the
presence of an inflamator process characterized by neutrophilic, eosinophilic elements and
regeneration’s elements – fibroblasts. Also, it was determined a pseudo synovial metaplasia and a villous
hyperplasia with formation of an synovial epithelium on the internal face of the induced membrane. The
histo-morphological exam performed at the 6 weeks has demonstrated the continuation of the
neoformating process and of the bone modelation, the regeneration process prevailed over the
inflammatory one. The morphological aspect was formed by agglomerations of fibroblasts, myoblasts
and collagen and numerous vascular buds, that promote a good neoangiogenesis and osteogenesis of the
bone.
Conclusion: The morphological study demonstrated an intense process of cell proliferation and
differentiation, which highlights the biological role of induced membrane by foreign body with secretion
of the osteoinductive factors, promoting the vascularization and corticalization of the bone. The Masquelet method is an effective method that allows getting the consolidation of the bone in case of
critical size bone loss.
Description:
Department of Orthopaedics and Traumatology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016