单纯 Ilizarov 环形外固定技术治疗合并骨筋膜室综合征的胫骨平台骨折

目的探讨单纯 Ilizarov 环形外固定技术治疗合并骨筋膜室综合征的胫骨平台骨折的疗效。方法2013 年 9 月—2017 年 3 月，收治 30 例合并骨筋膜室综合征的胫骨平台骨折患者，采用单纯 Ilizarov 环形外固定技术治疗。男 23 例，女 7 例；年龄 23～43 岁，平均 34.4 岁。致伤原因：交通事故伤 12 例，高处坠落伤 4 例，摔伤 8 例，重物砸伤 6 例。受伤至入院时间 1～12 h，平均 4.8 h。骨折 Schatzker 分型：Ⅱ型 1 例、Ⅲ型 3 例、Ⅳ型 10 例、Ⅴ型 7 例、Ⅵ型 9 例。30 例均因骨筋膜室综合征行切开减压；切开减压至手术时间为 10～15 d，平均 12.5 d。治疗后采用膝关节学会评分系统（KSS）及 Ilizarov 方法研究与应用协会（ASAMI）协议评价膝关节功能。结果手术时间 110～155 min，平均 123.1 min；术中出血量 100～500 mL，平均 245 mL；术后住院时间 3～5 d，平均 3.8 d。患者均获随访，随访时间 20～24 周，平均 22.7 周。除 2 例患者出现针道感染征象外，无其他并发症发生。X 线片复查显示骨折均愈合，愈合时间 10～20 周，平均 14.6 周。末次随访时，膝关节 KSS 临床评分总分为 70～95 分，平均 87.5 分；功能评分总分为 70～90 分，平均 79.0 分。参照 ASAMI 协议评价获优 24 例、良 3 例、可 2 例、差 1 例。结论对于合并骨筋膜室综合征的胫骨平台骨折，单纯 Ilizarov 环形外固定技术治疗后患者关节功能可以基本恢复且并发症少，是一项相对安全、有效的治疗方法。     

Ilizarov技术矫正儿童僵硬型马蹄内翻足畸形

[目的]探讨Ilizarov技术矫正僵硬性马蹄内翻足畸形的方法和效果。[方法]作者在2000年3月～2005年3月间，使用Ilizarov技术矫正9例11足重度僵硬性马蹄内翻足畸形，将连接于胫骨、跟骨、跖骨的外固定环互相连接、组合成复杂的三维外固定架，通过逐渐调整外固定架矫正畸形，从而使患足达到或接近正常足的外形和功能。[结果]按Garceau标准评定疗效，优6足，良4足，差1足。[结论]Ilizarov外固定架三维矫正马蹄内翻足畸形效果确实，尤其适用于大年龄儿童之僵硬、复发或难治性马蹄内翻足，有一定的临床应用价值。     

Ilizarov牵伸技术在外伤性垂足治疗中的应用

[目的]探讨应用Ilizarov牵拉技术治疗外伤性垂足的疗效。[方法]自2004年12月~2006年2月采用Ilizarov技术治疗8例外伤性垂足患者,其中男5例,女3例;年龄28~52岁,平均34.6岁。垂足产生原因小腿胫前外侧肌群断裂或缺损3例,小腿骨筋膜室综合征2例,腓总神经损伤2例,股骨髁上骨折并腘动脉断裂1例。踝关节强直范围为跖屈50°~65°。术中将准备好的牵拉架套入小腿及足部的相应位置。在钢环对应平面交叉穿入2mm克氏针并固定于Ilizarov牵拉架上,术后3~5d开始以1~2圈/d,4次/d的速度旋转踝关节前、后方的调节螺纹杆,使足环带动患足逐渐背伸,使垂足畸形逐渐得以纠正。当垂足提拉达到或超过中立位后停止牵拉,但继续使用牵拉架固定2~3个月以巩固疗效。[结果]所有患者均获随访,随访时间为10~21个月,平均12.5个月。患足均矫正至中立位,有3例患者踝关节可主动背伸至10°,行走功能均良好。有1例患者1个针道发生感染,经输用抗生素,加强针道护理,保证针道引流通畅,感染逐渐控制。无1例发生皮肤坏死、神经、血管损伤等并发症。全部患者垂足畸形无复发。[结论]应用Ilizarov牵拉技术治疗外伤性垂足较以往的治疗方法有明显的先进性,值得推广。     

Efficacy of a compliant semicircular Ilizarov pin fixator module for treating infected nonunion of the femoral diaphysis

Percutaneous transosseous Ilizarov wiring, whilst preferred in the tibia because of its unique properties, carries a high risk of complications in the femur. The aim of this work was to evaluate the efficacy of a more patient-friendly semicircular pin external fixator module built up from parts of the Ilizarov fixator components and its use in managing diaphyseal femoral nonunions. A group of 20 patients with infected diaphyseal nonunions of the femur after internal osteosynthesis were included in this study. The mean age of the patients at the time of surgery was 46 years (range 16–60, SD 15.6). The mean morbidity time since the original trauma was 10.2 months (range 6–15, SD 2.5). All the cases were fixed by the described external fixator module. Bony union with resolution of infection occurred in 18 (94.7 %) out of 19 cases after a mean period in the fixator of 11.2 months (range 8–18 SD 2.9). After a mean follow-up period of 3.5 years (range 2–9, SD 2.6), there were 14 excellent, 3 good, 1 fair and 1 poor results from radiological evaluation and 10 excellent, 7 good, 1 fair and 1 poor results from functional assessment. In conclusion, the described semi-circular pin fixator module is patient-friendly and effective in managing infected nonunions of the femoral diaphysis.     

Ilizarov bone transport after massive tibial trauma: Case report

IntroductionThis is a case report of extreme lengthening of the tibia of about 14.5 cm using bone transport technique following road traffic accident trauma to the lower limbs. The management of the subsequent massive skeletal defects was challenging to orthopedic surgeons. Based on reported cases, the highest tibial lengthening was 22 cm using bifocal transport, while the highest unifocal tibial lengthening reached 14.5 cm.Case presentationA 20-year-old male driver was brought to the emergency department after a road traffic accident. The patient had a right Gustilo IIIA segmental open tibia fracture with bone loss and other severe injuries. The tibial defect was 14.5 cm and the patient was then admitted for Ilizarov application six months after the accident. Although this case was particularly complicated, full limb length was restored.DiscussionThe management of this case was directed to correct the deformities and achieve equal length of both limbs to restore the normal function. Several new techniques have been developed recently to fill large bone defects. Limb lengthening using bone transport technique by application of Ilizarov ring fixator has been suggested as the leading option in filling massive bone gaps.ConclusionThe use of bone transport technique using Ilizarov external rings has proved to be a minimally invasive and reliable method in managing massive bone defects. Accurate application of the Ilizarov frame and proper transport of the middle segment are important factors alleviating the risk for deviation of the transported segment. However, due to the need for regular follow-ups and monitoring, it demands high compliance from the patient to achieve optimal results.     

应用 Ilizarov 技术胫骨横向骨搬移术治疗合并全身性炎症反应综合征的重度糖尿病足

目的探讨应用 Ilizarov 技术胫骨横向骨搬移术治疗合并全身性炎症反应综合征（systemic inflammatory response syndrome，SIRS）的重度糖尿病足（Wagner 3～5 级）的临床疗效。方法2014 年 8 月—2017 年 12 月，采用 Ilizarov 技术胫骨横向骨搬移术治疗合并 SIRS 的重度糖尿病足患者 33 例。其中男 27 例，女 6 例；年龄 34～79 岁，平均 60.6 岁。均患 2 型糖尿病，糖尿病病程 1～28 年，平均 10 年。糖尿病足病程 1～12 个月，平均 2.7 个月。根据 Wagner 分级，3 级 8 例，4 级 23 例，5 级 2 例。术后观察患足创面愈合情况, 并计算保肢率。评估体温、心率、呼吸频率、白细胞计数、红细胞沉降率和 C 反应蛋白浓度变化。测量足背皮肤温度；行疼痛视觉模拟评分（VAS）评价患足疼痛改善情况。结果术后 33 例患者均获随访，随访时间 3～30 个月，平均 14.1 个月。足部溃疡全部愈合，愈合时间 3～12 个月，平均 5.3 个月；保肢率 100%。术后体温、心率、呼吸频率、白细胞计数、红细胞沉降率和 C 反应蛋白浓度均较术前显著下降（P<0.05）。术后 1 个月患足皮温为（32.64±2.17）℃，较术前的（31.28±1.99）℃ 显著改善（t=0.05，P=0.00）；但与健侧皮温（32.46±2.10）℃ 比较差异无统计学意义（t=2.04，P=0.41）。术后 1 个月 VAS 评分为（2.4±0.7）分，较术前的（4.3±0.8）分显著改善（t=3.10，P=0.00）。 结论Ilizarov 技术胫骨横向骨搬移术能有效治疗合并 SIRS 的重度糖尿病足，可促进患足溃疡愈合，避免截肢。     

伊里扎诺夫技术修复兔胫骨骨缺损成骨机制的研究

目的探讨截骨推移区骨愈合的组织学特点和新骨形成规律。方法取青紫蓝兔24只,建立胫骨大段骨缺损模型,在近干骺端截骨。分别于截骨后第1、2、4、6、8、10周各处死4只兔,在近干骺端的分离区取材进行组织学观察。结果截骨后第1周出现血肿机化,第4周出现膜内成骨和软骨内成骨,第6周推移区大部分被骨性骨痂取代,第8周开始改建。结论推移区存在膜内成骨和软骨内成骨2种方式,以膜内成骨为主。     

The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan

We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a second visit, we reviewed all patients treated during our first mission. In addition, we treated 13 new patients with complex non-unions. Eight of these patients were deemed to be infected. All patients had previous treatment with monolateral fixators as well as soft tissue coverage procedures, except one patient who had had an IEF applied by another team. All these patients had revision surgery with circular frames. All patients from both groups were allowed to fully weight-bear post-operatively, after a short period of elevation to allow the flaps to take. Overall, all fractures united except one case who eventually had an amputation. Four patients had a corticotomy and lengthening, and three of them had a successful restoration of limb length. The fourth patient was the one with the eventual amputation.     

Ilizarov外固定架治疗胫骨骨缺损及骨短缩

目的探讨应用Ilizarov外固定架治疗胫骨骨不连及骨缺损的方法及临床疗效。方法对19例胫骨骨不连及骨短缩患者（肢体短缩4~17cm,平均9cm）,根据Iuizarov治疗原则,采用微创截骨、直接拉伸延长或骨段滑移术修复骨缺损和延长肢体,在连续硬膜外麻醉下手术置入外固定架。骨不连者调整外固定架使骨断端对合并加压;骨缺损短缩者则做骨段搬移术或直接拉长。定期复查X片,直至骨愈合满意后拆除外固定架。结果本组术后经1～5年随访。所有骨缺损愈合,肢体长度恢复正常或接近正常,感染无复发。结论Ilizalov外固定架技术是治疗胫骨大段骨缺损的有效方法。软组织感染创面可在骨段滑移中逐渐缩小并闭合,骨感染可在骨段滑移中逐渐被控制并随骨连接而愈合。