Kocaoğlu Mehmet, Eralp Levent, Sen Cengiz, Cakmak Mehmet, Dincyürek Hakan, Göksan S Bora
Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, 34390 Capa, Istanbul, Turkey.
J Orthop Trauma. 2003 Sep;17(8):543-8. doi: 10.1097/00005131-200309000-00001.
Hypertrophic nonunions can be managed successfully with distraction. Hypertrophic changes indicate that the tissue at the nonunion site has a biologic healing potential. The missing component is an appropriate mechanical environment to transform a hypertrophic nonunion into solid bone.
At our institution, the records of 10 male and 6 female patients treated for stiff hypertrophic nonunion with the Ilizarov distraction method were retrospectively analyzed. The average age of the patients was 42.3 years (range 15-69 years). The nonunion time ranged from 8-48 months. All patients had at least 1 cm shortening, 3 patients had a deformity in one plane, and 13 had a deformity in two planes. The pathology was localized to the upper extremity in 5 patients, to the lower extremity in 11 patients, with a periarticular localization in 11 patients. An Ilizarov-type circular external fixator was applied in all patients to correct shortening, to correct deformity, and to achieve a solid union.
All nonunions healed at an average follow-up of 38.1 months (range 24-95 months). The average time spent in the external fixator was 7.1 months (range 5-10 months). The average preoperative length discrepancy was 2.25 cm (range 1-8 cm), which was eliminated in all patients at the time of frame removal. The average coronal plane angulation of 19.7 degrees (range 15-37 degrees) and sagittal plane angulation of 20.8 degrees (range 5-45 degrees), together with translation in one patient, also were corrected to normal anatomic alignment. Complications included minor pin tract infections and hardware problems; recurrence of deformity was observed in one patient who refused to wear a protective brace after frame removal.
Hypertrophic nonunions can be managed successfully with distraction. The Ilizarov device can address every aspect of a stiff hypertrophic nonunion, including shortening and deformity.
肥厚性骨不连可通过骨延长成功治疗。肥厚性改变表明骨不连部位的组织具有生物学愈合潜力。缺失的要素是将肥厚性骨不连转化为坚实骨组织的合适力学环境。
在我们机构，对采用伊利扎洛夫骨延长方法治疗僵硬性肥厚性骨不连的10例男性和6例女性患者的记录进行回顾性分析。患者平均年龄42.3岁（范围15 - 69岁）。骨不连时间为8 - 48个月。所有患者至少有1厘米的短缩，3例患者在一个平面有畸形，13例患者在两个平面有畸形。5例患者的病变局限于上肢，11例患者局限于下肢，11例患者为关节周围病变。所有患者均应用伊利扎洛夫环形外固定器来纠正短缩、矫正畸形并实现牢固愈合。
所有骨不连在平均38.1个月（范围24 - 95个月）的随访中均愈合。外固定器平均使用时间为7.1个月（范围5 - 10个月）。术前平均长度差异为2.25厘米（范围1 - 8厘米），在拆除外固定器时所有患者的该差异均已消除。平均冠状面成角19.7度（范围15 - 37度），矢状面成角20.8度（范围5 - 45度），1例患者伴有移位，均矫正至正常解剖对线。并发症包括轻微的针道感染和外固定器问题；1例患者在拆除外固定器后拒绝佩戴保护性支具，出现了畸形复发。
肥厚性骨不连可通过骨延长成功治疗。伊利扎洛夫装置可解决僵硬性肥厚性骨不连的各个方面问题，包括短缩和畸形。
