应用Ilizarov技术进行肢体延长

目的 应用Ilizarov技术进行肢体延长，探讨其对骨愈合过程中的影响。方法 1991／1999年应用Ilizarov技术治疗肢体不等长39例，男22例，女17例，年龄8～15岁，平均12．5岁。肢体短缩3～12cm，平均6cm，均采用改良干骺端皮质骨截骨术，术后7d开始延长，lmm／d，分2～4次完成。延长l周后拍X线片，了解截骨是否完全、截骨对位对线情况，如有轴向偏移等，随时调整。以后每3周拍x线片1次，了解延长情况，新骨形成情况，达到预期延长长度后停止延长，带外固定架至延长区获骨性愈合后去除外固定架。结果 所有病例均达预期延长长度，延长2．0～14．5cm，平均7cm，胫骨延长3～12cm，股骨4～l0cm，胫骨、股骨同时延长11．0～14．5cm，尺骨2．0～3．5cm，愈合指数25～43d／cm，平均3ld／cm。结论 Ilizarov延长技术合理，手术切口小，创伤小，骨膜剥离少，对局部血供破坏小，明显缩短了截骨愈合时间。     

应用Ilizarov外固定延长技术治疗胫骨骨缺损

目的:探讨应用Ilizarov外固定架延长技术治疗胫骨骨缺损的疗效。方法:采用Ilizarov外固定架延长技术治疗胫骨骨缺损15例。术前根据患肢最大周径、内踝到胫骨结节长度、病灶范围和骨缺损长度设计Ilizarov外固定延长架。手术彻底清除病灶区炎性肉芽、坏死组织及死骨块,把外固定延长架套入小腿,在相应胫骨部位进行穿针固定和干骺部截骨,手术后4~7 d以1.0 mm/d的速度进行延长。结果:经7~16周(平均12周)推进延长,骨缺损两断端会合,继续维持外固定架固定3~9个月(平均6.5个月)达到骨性愈合。实施骨延长未发生错位或明显偏离轴线。其骨延长5.0~15.0 cm,平均8.5 cm。对15例患者进行疗效评定,优5例,良7例,可2例,差1例。结论:应用Ilizarov外固定架延长技术治疗胫骨骨缺损,创伤小,能有效缩短骨不连的治疗时间。     

Ilizarov技术治疗胫骨慢性骨髓炎

目的探讨应用Ilizarov技术治疗胫骨慢性骨髓炎的效果。方法对15例慢性骨髓炎患者实施Ilizarov外固定架固定、骨髓炎病段切除+万古霉素骨水泥串珠填充或旷置、胫骨近端截骨骨搬运的手术,术后10 d开始以每天1 mm的速度向远端搬移,经9~19周实现搬运骨与远端胫骨的会师。结果其中6例会师后实现了一期愈合,8~10个月后拆除了外固定架,9例在会师3个月后无愈合迹象,其中7例行会师端软组织清除+硬化骨切除手术后获得愈合,2例行自体髂骨植骨后获得愈合,12~14个月后拆除外固定架。拆除外固定架后肢体长度及力线良好,均未出现骨髓炎复发及再次骨折,完全临床治愈。结论 Ilizarov技术不但能有效地实现骨延长,而且肢体在牵拉应力下能实现一定程度的软组织修复,是治疗慢性骨髓炎的一种可靠方法。     

骨外固定与骨迁移治疗慢性股骨骨髓炎的疗效报告

目的探讨应用大段病骨切除＋旷置及截骨延长治疗股骨慢性骨髓炎、骨不连的临床效果。方法在2004年1月至2009年1月期间我院收治的20例慢性股骨骨髓炎患者报告,根据股骨大最大周经,股骨髁至股骨大长度,依据X光片判定的病骨切除范围和截骨位置,设计组装好改良的Ilizarov外同定架。手术彻底切除病骨及周边坏死组织,在股骨上干骺端截骨。术后7d以0．7～1．0mm／d速度延长。结果经8～15周（平均11周）固定延长至骨缺损端会师。继续维持外固定架固定,平均7个月,达到临床骨性愈合。其截骨延长区及骨缺损对合处均对位对线良好。结论该方法手术操作难度不高,安全可靠,术后维护简单,效果理想。无需内固定和植骨,并发症少,是一种有效地治疗创伤性及感染性股骨长段骨髓炎及骨不连的理想术式。     

Ilizarov骨延长治疗胫骨感染性骨折不愈合伴大段骨缺损13例效果观察

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。方法自2009年1月至2013年10月,应用Ilizarov技术治疗胫骨感染性骨折不愈合伴骨缺损患者13例。清创术后骨短缩缺损5~16 cm,平均缺损9 cm;皮肤缺损5 cm×8 cm~10 cm×10 cm。所有患者行Ⅰ期胫骨截骨术,术后第7天后开始行骨搬运与皮肤延长,4次/d,每次1/4 mm。结果本组13例患者均获5~24个月随访,平均16.2个月,均获稳定骨折愈合。骨外固定时间8~14个月,平均9.64个月。其中,1例针道感染,1例在骨对接端仍有分泌物,2例对接端部分缺乏血运而造成断端硬化,1例对线不良,上述患者经对症处理后均得到良好疗效。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。     

骨搬移治疗胫骨感染性骨缺损5例

目的探讨骨搬移治疗胫骨感染性骨缺损的临床疗效。方法采用骨端清创、单臂外固定支架固定及胫骨干骺端截骨骨搬移治疗胫骨感染性骨缺损。结果所有患者均获得随访,随访时间平均12个月,骨折均愈合,3例双下肢长度基本恢复一致,2例仍有1．5—2cm肢体短缩畸形存在。术后截骨端骨延长4～8cm,平均延长5．6cm,无血管及神经损伤的症状出现,所有病例骨延长区新骨组织形成良好。结论骨搬移是治疗胫骨感染性骨缺损的理想方法。     

外固定架联合髓内钉股骨重建术的围术期护理

总结了5例外固定架联合髓内钉治疗股骨缺损及短缩患者的围术期护理.术前针对患者治疗时间长、手术次数多、痛苦大且影响工作和生活等特点做好针对性的心理疏导及患肢术前准备.术后护理包括外固定架及针道的护理,严格执行延长计划;严密观察延长肢体末梢血液循环、足背动脉搏动、肢体感觉运动功能的变化;对于股骨短缩患者,股骨延长达到预期长度后将髓内钉远端锁定,然后去除外固定架,而对于股骨缺损患者,骨延长达到预期长度新生骨痂密度有所增加后再将髓内钉远端锁定去除外固定架.进行膝关节的早期功能锻炼.5例患者平均随访36.4个月(22～47个月),平均延长长度7.2cm(4～10cm),外固定架放置时间平均5个月(3～8个月),所有患者股骨未出现轴向偏移或再骨折,坚实化良好.5例患者膝关节活动度平均107°(80～ 135°).生活质量明显改善.股骨外有很厚的软组织袖,长期使用外固定架容易并发针道感染,联合应用髓内钉内固定,缩短了外固定架放置时间,有利于皮肤的护理.进行早期锻炼,可以促进膝关节功能的恢复.     

Ilizarov外固定治疗肢体不等长并发症的护理对策

目的探讨应用Ilizarov外固定架治疗肢体不等长并发症的护理对策。方法针对20例肢体延长过程中神经血管损伤、肢体水肿、针道感染、肌肉挛缩、关节僵硬、骨端延迟愈合、骨折等并发症进行分析。结果20例患者平均随访3年,下肢平均延长6cm,上肢平均延长2cm,延长端骨痂生长好,假关节消失,均达到骨性愈合,延长过程中未出现骨折及延长长度回缩。结论加强护理,正确处理和预防并发症的发生,是肢体延长手术成功与否的关键。     

Ilizarov肢体延长术后的护理配合

肢体不等长是小儿矫形外科中的常见病，医院于２０００年６月～２００１年２月对５例单侧肢体短缩病例采用Ilizarov技术进行骨延长，术后辅以康复护理，经随访疗效满意。１对象与方法５例患者中，男４例，女１例。年龄１０～１２岁，平均１１岁。５例病例均为单侧，２例股骨和胫腓骨先天性发育不良；１例左侧腓骨先天性缺损；１例右足第４～５趾先天性缺损；１例右侧股骨下端外伤性骨骺早闭，短缩长度３．０～７．４cm，平均５．２２cm。２例作股骨延长，３例作胫骨延长，延长长度４～８cm，平均６．２cm。方法：术后最初１周肢体会出现肿…     

Ilizarov外固定架应用并发症的观察及护理

我院应用 Ilizarov外固定架 ,治疗各种病因引起的肢体不等长 52例 ,疗效较满意。改善了由于疾病给患儿带来的外观及生活上的不便 ,解除了患儿身心的痛苦。但是尽管手术方法的改进和固定架的不断革新 ,延长中及延长后的并发症仍然很高 ,严重影响了治疗效果 ,甚至引起难以挽回的后患。通过对 52例患儿的观察及护理 ,对常见和特殊并发症的观察及护理取得了一定的经验 ,现将护理体会报告如下。1　临床资料患儿 52例 ,平均 1 2岁 ,肢体短缩 2～ 9cm不等 ,结果 :下肢延长 1 7～ 67mm,平均 48mm,愈合指数 2 3～ 85d/cm,平均 34d/cm;上肢桡骨远端延…     

骨搬移、骨延长术治疗长骨慢性骨髓炎和感染性骨不连体会

目的探索分析IIizarov骨搬移、骨延长术治疗长骨感染和肢体短缩,以及感染所致骨折不愈合的临床疗效。方法回顾性分析2011年6月-2013年10月,用骨感染病灶清除、IIizarov外固定支架固定及骨干骺端截骨骨搬移和骨延长术治疗13例长骨感染、缺损的股骨、胫骨和腓骨慢性骨髓炎和感染性骨不连患者,其中股骨和胫骨慢性骨髓炎8例（伴股骨病理性骨折1例）,感染性骨不连4例;腓骨慢性骨髓炎1例。结果13例患者感染均得到一期治愈,窦道愈合,骨搬移结合处正常愈合。其中2例出院后自行搬移过程中出现钉道感染（1例经再次清创后治愈,1例经清创后感染复发截肢）,1例在骨愈合后发生再骨折,经髓内钉固定后骨折愈合。13例患者骨搬移长度5～13cm,平均7．5cm;13例患者中有11例骨搬移后双下肢等长,2例患侧下肢较健侧下肢短缩。所有患者未出现神经损伤。结论IIizarov骨搬移和骨延长技术是治疗长骨感染及感染性骨不连的一种有效办法,手术可祛除感染,治愈窦道,恢复肢体长度,从而解决患者痛苦,提高其生活质量。     

Limb lengthening in automatic mode

Background. More than 5000 lengthening procedures in the upper and lower limb bones were performed at the Russian Ilizarov Scientific Centre, including 406 segments that were lengthened in automatic mode. Distraction was continuous, 24 hours a day, at a rate of 1 mm over 60 operating cycles of the autodistractor. Material and methods. Lengthening in automatic mode was used in 171 patients between the ages of 5 and 43. Monosegmental and polysegmental osteosynthesis techniques were applied. The amount of lengthening ranged from 3 to 16 cm. The mean value of lengthening by the monosegmental type of osteosynthesis was 6.1 +/- 2.0 cm, and by polysegmental techniques, 7.2 +/- 1.5 cm. The distraction forces developed in the autodistractor were also measured. In order to develop an objective opinion about the advantages of automatic distraction, we calculated the fixation index in the apparatus for one centimeter of lengthening. Results and conclusions. The fixation index was only 5-6 days/cm when using automatic distraction, but came to 22-24 days/cm by manual adjustment of lengthening. The biochemical study of bone metabolism during lengthening showed expressed activity of blood enzymes, such as alkaline and acid phosphatases, as well as large amounts of minerals in the distraction osteogenesis area.     

Ilizarov牵拉架外固定治疗胫骨骨缺损的钢环参数选择

背景：既往尚无有效的方法彻底治疗胫骨骨缺损合并软组织缺损。Ilizarov技术的应用能在一定程度上解决短缩畸形、软组织损伤及关节挛缩等相关问题。 目的：探讨Ilizarov牵拉架外固定治疗胫骨骨缺损的效果及钢环的参数选择情况。 方法：回顾性分析2007年3月至2012年1月收治且获得完整随访的胫骨骨缺损67例患者的临床资料,所有患者均为既往有胫骨骨折并一期行手术治疗,治疗后有胫骨骨髓炎合并骨与软组织损伤,在患肢上安放Ilizarov环形架外固定。比较外固定后1,3,6个月及末次随访时胫骨缺损长度和软组织缺损面积,观察外固定前后踝关节Kofoed评分和膝关节ROM评分有无差异,末次随访时根据Johner-Wruhs胫骨干骨折诊疗评价标准评定功能恢复情况。 结果与结论：67例均得到随访,时间6-35个月。67例骨缺损得以重建,骨折愈合,但其中5例效果较差;44例软组织缺损病例中,40例创面闭合,4例创面未愈合。外固定后1,3,6个月及末次随访胫骨缺损长度和软组织缺损面积均较外固定前改善（P 〈 0.05）;外固定后踝关节Kofoed评分及膝关节ROM均较外固定前改善（P 〈 0.05）;末次随访时各种治疗方案疗效评价优良率为85%。对于合并皮肤缺损的胫骨骨髓炎性骨缺损,应用Ilizarov技术治疗胫骨骨缺损创伤小,能够避免多次复杂手术,缩短治疗时间和节省治疗费用,但也有一定的缺点和局限性。选用Ilizarov环形外固定架钢环的大小和材质对外固定效果和固定后调整均有一定影响。     

Illizarov环形外固定架辅助下骨搬移术治疗胫骨长段骨缺损的疗效分析

【目的】探讨应用Illizarov环形外固定架辅助下骨搬移术（简称骨搬移术）治疗创伤性胫骨长段骨缺损的疗效。[方法]2000-2007年采用骨搬移术对12例创伤性胫骨长段骨缺损进行治疗,缺损5．3～11cm,平均7．3cm。参照Enneking系统对患肢进行功能评价,并分析其骨性愈合时间、带外固定架时间、手术后患肢功能恢复程度。【结果】随访时间12～51个月,平均38个月。12例骨缺损均达到骨性愈合,平均骨性愈合时间为8．4个月,平均带外固定架时间为12个月,术后患肢长度平均延长7．3cm,功能恢复程度为82％。【结论】骨搬移术治疗创伤性胫骨长段骨缺损具有较好的疗效、并发症发生率低、可随时调整纠正畸形等优点,是治疗骨缺损并发骨感染的有效方法。     

The surgical treatment of short stature: management strategy and local experience

Background. This article presents the indications and counterindications for the application of limb lengthening using distraction osteogenesis in the treatment of patients with short stature. Various treatment strategies are described. The factors influencing the choice of strategy are discussed, the means used to determine the extent and level of lengthening, and the optimum age to begin treatment. Material and methods. On the basis of their own material the authors present the problems, obstacles, and complications occurring during treatment. During the period 1997-2000 a total of 5 patients were treated for short stature, averaging 18 years of age. In these cases the "crossed" technique of surgical treatment was applied, using an Ilizarov apparatus on the tibia and an Italian modification on the leg. Results. A total of 8 tibial segments (ave. 7 cm) and 8 femoral segments (ave. 7.5 cm) were lengthened. The average increase in stature was 14.8 cm (a 12% increase over the growth prior to treatment). Conclusions. The methods applied produced good results in patients with non-proportional dwarfism, while the majority of complications involved patients with constitutionally short stature. This confirms the necessity to make a strict selection of healthy persons undertaking to increase their stature for cosmetic reasons.     

Fracture threshold in the femur and tibia of people with spinal cord injury as determined by peripheral quantitative computed tomography

OBJECTIVE: To determine bone traits of the femur and tibia with peripheral quantitative computed tomography (pQCT) that best distinguish between spinal cord injury (SCI) subjects with and without fractures. DESIGN: Cross-sectional study. SETTING: In- and outpatient paraplegic center in Switzerland. PARTICIPANTS: Ninety-nine motor complete SCI subjects (duration of paralysis, 2 mo-49 y), 21 of whom had sustained fractures of the femur or tibia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects with SCI were questioned about the occurrence, location, and approximate date of fractures to their lower extremities. Trabecular and cortical bone mineral density (BMD), as well as bone geometric properties of distal epiphyses and midshafts of the femur and tibia, were measured by pQCT. RESULTS: Trabecular BMD of the femur and tibia distal epiphyses was found to distinguish best subjects with fractures from those without. Fractures occurred in subjects with trabecular BMD of less than 114 mg/cm 3 and less than 72 mg/cm 3 for the femoral and tibial distal epiphysis, respectively (corresponding to 46% and 29% of mean values of an able-bodied reference group). Approximately 50% of the subjects with chronic SCI (defined as time postinjury >5 y for femur data and >7 y for tibia data) had trabecular BMD values above the fracture threshold in the femur and about one third above the fracture threshold in the tibia. CONCLUSIONS: By using pQCT, it may be possible to identify subjects with SCI who are at risk of sustaining fractures of the femur and tibia through minor trauma.     

保留骨骺灭活再植术治疗儿童股骨远端骨肉瘤及术后肢体功能恢复特征

背景:保留骨骺保肢手术在改善肢体功能、避免术后肢体不等长方面较截肢术有明显的优势,但术后并发症也较截肢手术有明显的增加,主要是感染、移植骨吸收、骨折和内固定松动等。目的:观察保留骨骺灭活再植术治疗儿童股骨远端骨肉瘤的术后肢体功能恢复情况。设计:临床定期随访观察。单位:解放军济南军区总医院。对象:选择于1999-01/2005-01在解放军济南军区总医院骨病科收治的11例骨肉瘤患儿,纳入标准:①经穿刺活检病理组织学证实为骨肉瘤。②化疗前在外院未行切开活检、放疗。③化疗前后经MR检查证实骨肉瘤未穿破骺板,侵袭骨骺,即骨肉瘤与骨骺MR分型中的Ⅰ、Ⅱ型[2]。④所有病变均位于股骨下端。排除标准:经胸片、CT扫描已有远处转移者。纳入患儿中男5例,女6例。年龄4～11岁,平均(8±2)岁。病程1～6个月,所有患儿监护人对手术项目知情同意。方法:①本手术中患儿均按照计划采用MMIA化疗方案用药2疗程,2周后进行保留骨骺的灭活再植术。以股骨远端骨肉瘤为例,硬膜外麻醉或全麻成功后,患儿平卧手术台,取膝关节前内侧切口,切开骨膜,向近端作骨膜下剥离。用线锯截断股骨,仔细分离后切断股骨后侧的骨膜,钝性分离股后侧的血管神经至腘窝,结扎至肿瘤内的血管。切断腓肠肌内外侧头在股骨后髁处的附着点。依据术前MR在距骺板5mm处确定股骨远端截骨平面,应用电锯截断股骨,并用无菌玻片作涂片,以细胞学证实无肿瘤细胞存在。髓内针固定股骨,以螺丝钉交叉固定骨骺,骨缺损处以骨水泥充填。逐层关闭,放置引流管1根。以长腿石膏托固定。术后处理:常规应用抗生素预防感染。引流管拔除的时间以引流量<50mL/d来确定。石膏托固定期间注意指导患儿行下肢功能锻炼。术后12～14d拆线。术后2周同样给予MMIA方案进行化疗。术后8周拆除外固定,开始膝关节功能锻炼,并扶双拐下地,需要扶拐4个月左右。②对手术中切除的标本按国内肿瘤坏死率的取材与评定方法进行评定术前化疗效果的评估。③术后患儿恢复情况分析:观察术后患儿切口血管、神经损伤和愈合情况,对所有患儿随访,通过检查患膝屈曲角度评价患膝功能(以最后随访时为评价标准)、双下肢长度、随访期间发生转移等指标评价11例患儿的行保留骨骺的灭活再植术后恢复情况,对回植的灭活骨与截骨端、骨骺端间的愈合情况进行了动态影像学观察,对术后并发症进行观察。主要观察指标:①术前化疗效果的评估。②术后恢复情况(患膝功能、双下肢长度、随访期间发生转移等指标)。③回植的灭活骨与截骨端、骨骺端间的愈合情况的动态影像学观察以及术后复发情况。结果:纳入患儿11例均获得随访。①术前化疗效果的评估:11例患儿中,Ⅳ级7例,Ⅲ级4例。②术后恢复情况:患儿术后无血管、神经损伤。术后切口一期愈合,无切口感染及切口延迟愈合。11例获得随访10～72个月,患膝屈曲≥110°3例,90°～110°3例,60°～90°4例,<60°1例。下肢等长4例,患肢较健侧短<2.0cm5例,2.0～3.0cm2例。复发1例,转移2例,死亡3例,螺钉松动1例,灭活骨骨折1例。③动态影像学观察结果:未见骨骺处有肿瘤复发。2个月时,6例患儿的灭活骨与骨骺处已基本愈合,灭活骨与骨干截骨处有骨痂形成,4个月时骨痂明显增加,6个月时,灭活骨与骨干截骨端完全愈合。④术后复发情况:随访期内发生螺钉松动1例,由于骨已愈合,将松动的螺钉取出;灭活骨与股骨干截骨处骨折1例,采用切开复位、植骨、环抱器内固定治疗,术后4个月复查见骨愈合良好,现已再次手术24个月,双下肢等长,膝关节可屈曲至110°。结论:保留骨骺灭活再植术有利于术后功能恢复和肢体长度的保持。     

X线联合超声对肢体延长术的监测价值

目的：比较普通X光片和B超检查在肢体延长中的作用,讨论两种检查方法在肢体延长术中的应用价值。方法：制作日本大耳白兔胫骨干截骨延长模型,术后7天开始延长,速率为1mm/d,延长到30%后停止延长矿化5周。利用普通X光片、多普勒超声观察肢体延长过程中延长区域骨痂及血运生长情况。结果：X线片：延长到第10天之前,延长区域看不到新生的骨痂,延长到30%,骨痂量明显增加,在截骨端开始出现骨皮质。矿化3周时开始出现髓腔。超声观察,延长初期延长区增生的血管及血流速度都有增加,以后逐渐较少,在延长1周左右开始有骨痂生成。延长到30%时,超声波已经很少能透过延长区域。结论：肢体延长过程中,普通X光片和超声检查各有优缺点,但是都必不可少,将两者联合应用,将是肢体延长术成功的必须条件。     

Differences in lower limb bone mineral density in children with anisomelia

Background. Lower limb discrepancy (anisomelia) can be caused by many different factors leading to shortening (90% of cases) or lengthening of a limb (10% cases). This article present the results of densitometric tests performed on patients treated for lower limb discrepancy in the Department of Orthopedic of the Silesian Academy of Medicine in the years 1997-1998.
Material and methods. Our research involved 57 patients, 31 girls and 26 boys. The Ilizarov technique was used to lengthen 33 femurs and 24 tibias. The average discrepancy was 45 mm (48 mm in the femurs and 42 mm in the tibias), and the patients average age was 13,8 years (range 7-26). The test were performed with a DPX apparatus by the Lumar Corporation. The bone mineral density (BMD) was measured in the area of the shortened limb segment and compared to the results of the analogous measurement of the opposite limb. The height of the measurement frame was 50 mm, and the width was equal to the width of the bone. The measurement field was located in each case at a distance of 3-4 cm (on the respective bone) from the line of the knee joint, in order to eliminate additional density caused by growth cartilage and the imposition of the patella. The repeatability of the tests was assured by a support maintaining constant internal limb rotation of 400.
Results. A difference in BMD between the shorter limb and the opposite limb was found in 47 children (82,5%). The average was 16,5%, whereas it was higher in the shorter femurs (19,1%, range 4,5 - 68,5%) than in the tibia (14%, 5,2 - 59,8%). A greater degree of demineralization was found in the girls (23,5%) than in the boys (20%). No correlation was found between the etiology of the shortening and the degree of calcification.
Conclusions. The results of these tests may have great significance in the case of densitometric monitoring of regenerated bone being formed in the course of lower limb by the Ilizarow method.