Ilizarov 外固定器治疗胫骨骨不连

目的 探索应用llizarov外固定器治疗胫骨骨不连的方法。方法 对16例病人依据骨不连的不同种类，采用不同种植骨术外用Ilizarov外固定器固定，外固定时间为4～9个月，平均6个月。结果 术后4～6周拍X光片检查均可见明显骨痂生长，随访1～4a，效果良好。结论 llizarov外固定器在治疗胫骨不连接中显示出适应性广泛，固定牢固，符合生物力学原则，骨痂生长迅速，早期离床活动，有利于关节活动等优点，该方法是治疗胫骨骨不连较为理想的方法之一，值得推广应用。     

Ilizarov外固定器治疗胫骨Cierny Ⅳ型感染性骨不连的临床疗效

目的探讨Ilizarov外固定骨牵移技术治疗胫骨CiernyⅣ型感染性骨不连的临床疗效。方法采用Il-izarov外固定骨迁移技术治疗35例胫骨感性骨不连患者。结果手术时间58～80(64±4.2)min。35例均获随访,时间14～33(19.6±6.2)个月。骨牵移长度4～10(5±2.2)cm,牵移骨痂矿化的时间为11～20(12.1±3.2)周,牵移骨段与胫骨截骨段接触后骨折愈合时间为13～26(15.9±1.3)周。3例出现马蹄足畸形,给予跟腱延长;2例出现骨不连,断端清理髂骨植骨后愈合;1例出现钉道热力性骨坏死,清创后治愈。疗效评定按Johner-Wruh评定:优22例,良8例,差5例,优良率达85.7%。结论 Ilizarov外固定骨牵移技术治疗胫骨感染性骨不连临床疗效满意。     

骨搬移治疗胫骨感染性骨不连

目的分析骨搬移治疗胫骨感染性骨不连的临床疗效。方法2002年10月至2007年10月采用胫骨感染骨端清创、重建外固定支架加压固定及胫骨干骺端截骨骨搬移治疗胫骨感染性骨不连、纠正肢体短缩畸形45例。结果45例胫骨感染均得到一期控制,软组织缺损创面消灭,4例出现钉道感染;44例骨折愈合,1例骨折端再次形成骨不连;39例双下肢长度基本恢复一致,6例仍有1．5～3cm肢体短缩畸形存在,1例因截骨端提前愈合使肢体未能达到预期长度;术后截骨端骨延长2～9cm,平均延长6cm,无血管及神经损伤的症状出现;术后外固定支架固定6～12个月,平均8个月,所有病例延长区新骨组织形成良好。结论采用骨搬移治疗胫骨感染性骨不连,能达到一次手术兼顾控制骨端感染、消灭皮肤创面、骨折端不需植骨达到骨性愈合及均衡肢体长度的临床治疗作用,是治疗胫骨感染性骨不连的理想方法。     

创伤后感染性胫骨骨不连的骨外固定治疗

１９８２－１９９５年，应用半环槽式外固定器成功的了２１例外伤后感染性胫骨骨不连，并对６例肢体短缩才重建了肢体长度。２１例均采用骨外固定器行骨断端加压固定，所有病便均行腓骨截骨术。合并肢体短缩者６例于同期或二期行胫呈下干骺端截骨延长术，以达到肢体长度的均衡。虽有再骨折、针道感染、钢针松动等并发症，但所有骨不连最终均达到愈合，创面感染快速得到控制。骨愈合时间３－１１个月，平均５个半月。肢体短缩者６均例     

骨外固定另压治疗胫骨干骨不连

目的：通过观察半环槽式外固定器治疗胫骨骨不连的治疗效果,评价加压外固定对骨损伤修复的作用。方法：采用半环槽式外固定器骨外加压固定治疗胫骨干不连４９例（男３７例,女１２例）,骨不连时间为７～１３２个月。其中７例感染性骨不连偏侧性骨缺损者,行病灶清除开放性植骨;５例感染性骨不连行病灶清除、内固定物取向、小腿皮瓣转位;１０有不连、骨缺损们伤肢短缩者,行胫骨干骺端截骨或骨骺牵伸延长。结果：植骨全部成活,创     

单臂外固定支架联合植骨治疗胫骨骨折骨不连

[目的]探讨单臂外固定支架联合植骨治疗胫骨骨折骨不连的优越性、安全性及疗效。[方法]自1996年以来应用单臂外固定支架治疗胫骨骨折骨不连43例，通过断端创新，自体髂骨植骨和轴向加压促进骨折愈合，早期活动以恢复关节功能。[结果]经术后6～15个月、平均10．3个月的随访，43例均获临床愈合，愈合时间为4—12个月，平均6．8个月，功能评价优35例，良7例，差1例。[结论]单臂外固定支架联合植骨治疗胫骨骨折骨不连，自体髂骨植骨和轴向加压促进骨折愈合，早期无痛关节活动有利于关节功能恢复，是一种即简便又切实可行的治疗方法。     

骨外固定加压治疗胫骨干骨不连

目的 :通过观察半环槽式外固定器治疗胫骨骨不连的治疗效果 ,评价加压外固定对骨损伤修复的作用。方法 :采用半环槽式外固定器骨外加压固定治疗胫骨干骨不连 49例 (男 37例 ,女 12例 ) ,骨不连时间为 7～ 132个月。其中 7例感染性骨不连偏侧性骨缺损者 ,行病灶清除开放性植骨 ;5例感染性骨不连行病灶清除、内固定物取出、小腿皮瓣转位 ;10例骨不连、骨缺损伴伤肢短缩者 ,行胫骨干骺端截骨或骨骺牵伸延长。结果 :植骨全部成活 ,创面植皮获Ⅰ期愈合 ,肢体延长幅度 4.5～ 13 .5cm ,平均 7.5cm ,达到预期目标 ,49例患者均于术后 2 .5～ 10个月 ,获得骨愈合 ,平均 5 .4个月。结论 :骨外固定加压治疗胫骨干骨不连不仅具有确实的效果 ,而且有以下优点 :(1)方法简便、创伤小、局部血运干扰少 ;(2 )在局部感染的条件下仍可使用 ;(3)骨端始终保持有均匀的压应力和肢体功能锻炼时产生的生理应力刺激 ,有利于促进骨愈合 ;(4)可配合肢体延长联合使用 ,既治愈了骨不连 ,又均衡了双下肢长度 ,有利于肢体功能恢复。     

外固定支架加植骨治疗胫骨骨折术后骨不连22例分析

目的 分析胫骨骨折术后骨不连的原因和手术治疗方法的选择.方法 2005年6月至2010年6月共收治胫骨骨折术后骨不连22例,均采用单侧多功能型外固定支架加植骨治疗.结果 术后平均随访15个月,未发生骨髓炎等并发症.经X线片检查,其中6～12个月骨性愈合13例,12～18个月骨性愈合6例,大于18个月骨性愈合2例,1例失访.结论 外固定支架加植骨是一种治疗胫骨骨折术后骨不连的较好方法.     

弹性外固定和负重治疗胫骨骨不连临床观察

采用穿针外固定，配合患肢负重功能锻炼治疗胫骨骨不连２２例。其中，１０例增殖型，１２例萎缩型。究其原因，１１例为内固定不良，４例为石膏、２例为自制夹板固定而达不到固定效果，５例为骨端感染所致。治疗经过８７～１８９天，平均１０３天，１９例在６个月内愈合，３例效果欠佳。疗效分析认为：骨不连主要由于不良治疗过分干扰骨折自然愈合过程，骨生长能力受到限制所致，弹性外固定可改善骨折端稳定性，提供弹性和间断生理压应力，不限制功能锻炼中肌泵的供血作用，有利于骨端生长能力的恢复。     

单臂外固定支架治疗胫骨骨不连

目的探讨胫骨下段骨不连的治疗方法.方法总结1998年3月至2003年9月采用单臂外固定支架治疗30 例胫骨骨不连的体会,所有病例均采用单臂外固定支架行骨折断端加压固定,去除内固定,无感染者行局部植骨,口服骨复生胶囊.结果 30 例骨不连最终均达到骨性愈合,非感染性骨不连骨愈合时间6～12个月,平均9个月,感染性骨不连骨愈合时间6～24个月,平均12个月.结论采用单臂外固定支架治疗此类骨不连,由于在远离病灶的部位穿针,对骨不连断端的血循环及骨潜能干扰小,有利于骨折愈合.     

Acute compression and lengthening by the Ilizarov technique for infected nonunion of the tibia with large bone defects

PURPOSE. To assess the Ilizarov technique in treating large infected tibial defects by resection of the infected focus, its acute compression, and gradual distant site lengthening. METHODS. 27 men (mean age, 39 years) with infected nonunion and large bone defects of the tibia underwent complete resection of the nonunion site, debridement, sequestrectomy, lavage, and Ilizarov ring fixator application. Patients underwent acute compression of the defect site, followed by distant site metaphyseal corticotomy for simultaneous lengthening. The mean length of resection was 10 (range, 6-17) cm. The mean follow-up was 27 (range, 25-39) months. RESULTS. The mean lengthening achieved was 10 cm, mean union time 6.3 months, and mean duration of consolidation 10.2 months. Functional results were excellent in 19 patients and good in 5. The union time was longer in older patients. CONCLUSION. Acute compression and simultaneous lengthening can be used safely for treatment of large bone defects in the tibia. This avoids secondary operations at the docking site and reduces the duration of treatment.     

Ilizarov技术自体骨段延长治疗胫骨感染性骨折不愈合伴骨缺损

目的 探讨Ilizarov技术自体骨段延长治疗胫骨感染性骨折不愈合的疗效.方法 2000年9月至2006年6月共收治胫骨感染性骨折不愈合伴骨缺损患者14例,男11例,女3例;年龄19～49岁,平均31.9岁;胫骨近端3例,中段8例,远端3例.原始损伤:5例为开放骨折钢板内固定,3例为开放骨折髓内钉内固定,4例为开放骨折外固定架固定,2例为闭合骨折钢板内固定术后所致.患者自受伤至此次治疗时间为2～24个月,平均7.54个月;手术次数平均6次(3～14次).根据Jain骨缺损和感染程度分型:A2型5例,B1型2例,B2型7例.窦道形成10例,骨外露4例;骨外露面积最大7 cm×5 cm,最小2 cm×1 cm;清创后骨缺损长度3～12 cm,平均6.71 cm.14例患者均采用清创联合Ilizarov技术自体骨段延长治疗.结果 14例患者均获8个月～6年(平均20个月)随访,均获稳定骨折愈合.住院时间1～7个月,平均3个月;骨折愈合时间6～12个月,平均7.79个月;骨外固定时间8～14个月,平均9.64个月.并发症:针道感染1例,皮肤过敏1例,骨折畸形愈合再截骨1例,提前矿化再截骨1例,断针1例,无深部感染、骨折不愈合和膝关节僵直发生.根据Paley骨折愈合评分标准:优13例,良1例.结论 Ilizarov骨段延长是治疗胫骨感染性骨折不愈合伴大段骨缺损的一种有效方法.     

The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method

The purpose of this study was to demonstrate the effectiveness of the Ilizarov method and circular external fixator in order to eradicate the infection and restore bone union, limb anatomy and functionality in cases with infected nonunion of the tibia following intramedullary nailing.During 7 years nine patients suffering from infected nonunion of the tibia after intramedullary nailing were treated in our department. The series comprised seven men and two women with an average age of 39.7 years (range 21-75 years). The patients had previously undergone an average of 4.8 operations (range 3-6 operations). Active purulent bone infection occurred in all nine patients. Bone defect was present in all patients with a mean size of 5 cm (range 2-12 cm). In three cases with bone defect less than 2 cm, monofocal compression osteosynthesis technique was used. In the rest cases where bone defect exceeded 2 cm, bifocal consecutive distraction-compression osteosynthesis technique was applied. Three patients required a local gastrocnemius flap. The mean follow-up period was 26.6 months (range 13-42 months). Results were evaluated using Paley's functional and radiological scoring system.Bone union was achieved in all nine patients without recurrence of infection during the follow-up period. Bone results were graded as excellent in five cases and good in the rest four cases. Functional results were graded as excellent in three cases, good in four and fare in two cases. Mean external fixation time was 187.4 days (range 89-412 days) and mean lengthening index was 32 days/cm (range 27-39 days/cm). Complications observed included eight grade II pin tract infections, axial deformity at the lengthening site in two cases and at the nonunion site in another two cases. Ankle joint stiffness was detected in five cases.The Ilizarov method may be an effective method in infected nonunions of the tibia following intramedullary nailing.     

应用Ilizarov技术治疗长管状骨缺损性骨不连

目的探讨和总结应用Ilizarov技术治疗长管状骨复杂缺损性骨不连的重建方式及疗效。方法1996年1月至2005年1月,收治长管状骨缺损性骨不连患者61例,男46例,女15例;年龄6～55岁,平均28.2岁。胫骨29例,股骨9例,肱骨11例,桡骨7例,尺骨5例。骨缺损长度4～14cm,平均6.4cm。选择骨缺损4￣6cm的30例患者行Ilizarov截骨肢体延长术,骨缺损6￣9cm的21例患者行Ilizarov骨节段截骨后传送延长术,骨缺损超过9cm的10例患者行同侧腓骨转移结合Ilizarov架固定术。平均骨延长4.8cm;随访时间10～84个月,平均47个月。结果61例骨缺损最终均达到骨性愈合,平均带架时间9个月,平均骨愈合时间7.1个月。21例78个针道低度感染和积液,原因为针道骨吸收和针道局部清洁护理差。1例腓骨转移患者带架期间摔伤后再骨折。股骨轴向偏移<3mm、向前外侧成角<10°者5例,其中股骨3例,肱骨2例,经调架后逐步矫正。结论应用Ilizarov技术修复长管状骨复杂缺损性骨不连的原则是彻底切除病灶,其次是考虑功能重建。Ilizarov技术是治疗长管状骨复杂缺损性骨不连、成功重建肢体长度的有效方法。     

Management of infected nonunion of the femur in adults using the Ilizarov technique

Background

Infected nonunion encompasses a series of complex problems including osteomyelitis, bone and soft tissue loss, osteopenia, adjacent joint stiffness, complex deformities, limb length discrepancies, and multidrug resistant multibacterial infections. Several surgical techniques were proposed for management of this major complication including intramedullary devices, free tissue transfer and in situ reconstruction, and the Ilizarov technique.

Aim of the study

The aim of this study was to revaluate the results of management of infected non-united fractures of the femur in adults using the Ilizarov frame.

Patients and methods

There were 20 patients with infected femoral nonunion, whom were managed using Ilizarov technique. The mean age of the studied patients was 37.45 years. There was only one female. Of the included patients, ten had diaphyseal fractures, two suffered from proximal metaphyseal fractures, and eight presented with distal metaphyseal nonunion. No patient was able to bear weight on the infected limb. All the patients had had previous surgeries, with a mean of 1.95 (SD 1.050 and range 1–5 previous surgeries). Debridement of the infected bone and soft tissues was performed in all the studied cases. Techniques adopted were acute compression in 5 patients, acute shortening in 13, and acute shortening and distant corticotomy in 2 patients: one proximal and one distal corticotomies. Periodic regular clinical, as well as radiographic, evaluation was performed. A minimum follow-up period of 2 years was an inclusion criterion in this study.

Results

The bone, (radiological) results, functional results, and complications were evaluated. The mean time between injury and the application of the frame was 10.15 (SD 8.798, range 3–35 months). The mean follow-up period was 36.65 (SD 15.849, range 25–82 months). The mean external fixation time was 8.03 (SD 2.774, range 5–15 months). The mean limb length discrepancy was 1.45 (SD 1.134, range 0–3 cm). Bony union was achieved in all except two patients. One patient had refractured 1 month after frame removal and union was managed by reapplication of the frame. Bone grafting was not performed in this study. Infection was controlled in all but one patient, in which the fracture did not unite. The radiological results were excellent in ten patients (50 %), good in six (30 %), fair in one (5 %), and poor in three patients (15 %). The functional results were excellent in 4 patients (20 %), good in 13 (65 %), and poor in 3 patients (15 %) and no fair results. In the studied 20 patients, there were 63 complications in total, (25 problems, 6 obstacles, and 32 true complications). From the encountered 32 true complications, 4 were defined as minor and 28 were considered as major complications.

Conclusion

Despite the high rate of complications, the Ilizarov technique was found to be effective in the treatment of infected femoral nonunion as it allowed simultaneous treatment of bone loss, nonunion, infection, shortening, and deformity.     

Ilizarov技术同期治疗感染性胫骨大段缺损并小腿软组织缺损

目的探讨Ilizarov技术同期治疗感染性胫骨大段骨缺损并小腿软组织缺损的疗效。方法回顾性分析2012-01—2014-05应用Ilizarov技术同期治疗8例感染性胫骨骨缺损并软组织缺损。均为胫骨骨折术后感染,清创后小腿软组织缺损位于胫前内外侧,面积平均为30.4(24~91)cm2,胫骨缺损长度平均为9.5(6~13)cm。7例胫骨中远段缺损采用胫骨结节下方截骨向远端骨搬运修复,1例胫骨近段缺损采用胫骨远端截骨向近端骨搬运修复,软组织缺损修剪成椭圆形后直接拉拢缝合。术后10 d开始骨段搬运,速度为1 mm/d,分4次完成。结果术后延长段切口及创面均一期愈合。所有患者均获随访17~36个月,平均23个月。延长段骨自然愈合,愈合时间为210~496 d,平均271 d;愈合指数3.4~4.0 d/mm,平均3.7 d/mm。对接点2例行二期植骨后愈合,其余6例均自然愈合,愈合时间170~308 d,平均236 d。去除外固定架后5个月疗效根据ASAMI评价标准评定:优6例,良2例。结论Ilizarov技术简便、疗效良好,是同期修复感染后大段胫骨缺损并软组织缺损的可靠方法。     

Two-stage treatment with sliding fibular flap technique for chronic infected nonunion of the tibia

Purpose: To assess the effectiveness of two-stage treatment with the fibular sliding technique in chronic infected nonunion of the tibia. Methods: The study included patients who were diagnosed with long-term chronic infected tibial nonunion following trauma and treated with the two-stage technique between January 2010 and November 2017. Patients with (1) intra-articular fractures of the distal third of the tibia and fibula, (2) pathological fracture resulting in bone loss or (3) neurological and vascular pathologies of the limbs were excluded. The operation consisted of two stages and the main goal in the first stage was to control the infection and in the second stage to control the healing of the bone. Functional & radiographic results and complications were evaluated according to Paley''s criteria. Results: The patients comprised 14 males and 5 females with a mean age of 37.4 years (range, 21-52 years). Patients were followed up for an average of 27 months (range, 15-38 months). The microorganisms produced from these patients were Staphylococcus aureus in 13 patients, Pseudomonas aeruginosa in 4 patients and no bacteria in 2 patients. After the first stage operation, superficial skin necrosis developed in 1 patient. In another patient, there was a persistent infection, although union was achieved. For the entire patient group, union was observed at the end of 7.44 months (range, 7-11 months). Based on Paley''s criteria, there were 16 (84.2%) patients with excellent scores, 2 (10.5%) good scores and 1 (5.3%) fair scores radiologically; while regarding the tibial function, 15 (78.9%) patients had excellent scores, 3 (15.8%) good scores, and 1 (5.3%) fair scores. No patients had poor radiological or functional score. Conclusion: Two-stage treatment can be considered as an alternative for fractures in regions that are susceptible to many and persistent complications, such as the tibia. This technique has the advantages of short operation time, minimal blood loss, no excessive tissue damage and not very technique-demanding (a short learning curve with no requirement for an experienced team).     

应用Ilizarov技术治疗胫骨感染性骨缺损并足下垂

目的 探讨应用Ilizarov技术治疗胫骨感染性骨缺损合并足下垂的临床疗效.方法 应用Ilizarov技术一期治疗胫骨感染性骨缺损伴足下垂13例.术前根据患肢最大周径,内踝到胫骨结节长度,足下垂角度,病灶范围和骨缺损长度设计Ilizarov外固定延长架,手术彻底切除病灶区炎性肉芽、坏死组织及死骨,把外固定延长架套入小腿,在相应胫骨部位进行截骨和穿针,术后8d以1.0 mm/d分3次延长胫骨,同时以3 mm/d的速度矫正足下垂.结果 13例均获得随访,时间12～36个月,平均18个月.所有患者胫骨延长段、骨折段均骨性愈合.结论 对于感染性胫骨缺损合并足下垂的患者,应用Ilizarov技术一期治疗创伤小,避免多次复杂手术,缩短治疗时间和节省治疗费用.     

Modified Ilizarov technique for infected nonunion of the femur: the principle of distraction-compression osteogenesis

PURPOSE. To evaluate the treatment outcome of the modified Ilizarov technique in infected nonunion of the femur. METHODS. Between 1989 and 2002, records of 20 patients with infected nonunion of the femur treated with the modified Ilizarov technique were retrospectively reviewed. The modified Ilizarov frame was fixed after necrectomy of the dead infected bone and tissues. A proximal or distal corticotomy was performed following biological principles. For regeneration of gap, segmental transport was performed in 11 patients with a gap of more than 5 cm; acute docking followed by lengthening at the corticotomy site was performed in 9 patients with a gap of smaller than 5 cm. Mobilisation was started early with active participation of the physical therapist and the patients. Bone and functional results were measured and complications were categorised according to the Association for the Study and Application of the Method of Ilizarov guidelines. RESULTS. The mean follow-up period was 62.8 months. Bony union and eradication of the infection was achieved in all patients except one who underwent amputation due to uncontrolled infection. Bone results were excellent in 13 patients, good in 4, fair in one, poor in one, and treatment failure (amputation) in one. Functional results were excellent in 3 patients, good in 9, fair in 3, poor in 4, and failure in one. A total of 71 complications occurred: 35 problems, 6 obstacles, and 30 true complications. The mean healing index was 38.3 day/cm (standard deviation, 1.6 day/cm). CONCLUSION. The Ilizarov technique is a good salvage operation for infected nonunion of the femur. Limb salvage is preferable to prosthesis if the limb is viable, adequately innervated and the patient is mentally and financially committed to save the limb.