Ilizarov外固定器治疗肥大性骨不连

 目的 探讨采用Ilizarov外固定器治疗肥大性骨不连的疗效。方法 回顾性分析2008年6月至2010年12月，采用Ilizarov环型外固定器直接牵张治疗肥大性骨不连患者的病例，男10例，女2例；年龄22～62岁，平均46.5岁；肱骨中段1例，股骨髁上2例，胫骨中段3例，胫骨中下1/3交界处6例；患肢畸形成角10°～35°，平均25°，其中2例为双平面畸形，10例为单平面畸形；肢体短缩2～6 cm，平均3.5 cm。所有患者术前均拍摄双下肢全长X线片。对骨断端尽量不切开，局部不植骨，直接安装预构的Ilizarov外固定器。对局部留存内固定物者，采用微创的方法取出，尽量保护骨断端血供。术后第7天开始进行矫形延长，断端处每天延长0.25 mm。在恢复肢体长度的同时，矫正成角畸形，对双平面畸形，先矫正冠状面畸形，再矫正矢状面畸形。结果 12例骨不连患者均通过断端直接牵张成骨而获得骨性愈合, 骨断端无需植骨。骨性愈合时间6～12个月，平均8个月。成角畸形和肢体不等长全部获得矫正。畸形矫正时间15～35 d，平均24 d。畸形矫正10°～30°，平均23°。患肢延长2.0～5.5 cm，平均3.0 cm。随访6～18个月，平均14个月，所有患者获得的矫形均未丢失。结论 肥大性骨不连断端间纤维骨痂有活跃的成骨潜能，采用Ilizarov外固定器治疗肥大性骨不连可取得满意的疗效。

Treatment of hypertrophic nonunion by using Ilizarov circular fixator

Objective To evalute the effect of Ilizarov technique in the treatment of hypertrophic nonunion. Methods Form June 2008 to December 2010, 12 patients with hypertrophic nonunion were treated with Ilizarov technique, including 10 males and 2 females with an average age of 46.5 years. The pathology sites of nonunion were kept as closed as possible without any bone graft during operation. As to patients who had ever been treated with plate or intramedullary nail, the hardware should be removed by minimal invasive approach. These procedures aimed to keep the vascularity of nonunion site intact. Ilizarov apparatus were preoperatively constructed. Distal segment and proximal segment of nonunion were mounted respectively with two external circle using the smooth wires and half pins. The two-circle stabilizing one segment was nominated with transosseous modules. Distal module and proximal one was connected with a pair of axial hinges. The pathology sites were gradually distracted from the seventh day postoperatively, 0.25 mm/d. Accompanying with deformity correction, limb length discrepancy (LLD) also were restored simultaneously. Then, all the screws and nuts in the apparatus should be tightened, which was favourable to the callus consolidation. Results All 12 cases of nonunion healed without any bone graft. The fixator wearing time lasted 6-12 months, with an average of 8 months. Correction of deformity and LLD were achieved. The average lengthening was 3.0 cm (range, 2.0-5.5 cm), the average correction angle was 23? (range, 10?-30?). After 6-18 months follow-up, all the patients restored satisfactory function. Conclusion Hypertrophic nonunion can be treated successfully with Ilizarov technique. The key of successful callus distraction is strictly identifying the indications.