Robert Rozbruch S, Weitzman Adam M, Tracey Watson J, Freudigman Paul, Katz Howard V, Ilizarov Svetlana
Hospital for Special Surgery, New York, NY 10021, USA.
J Orthop Trauma. 2006 Mar;20(3):197-205. doi: 10.1097/00005131-200603000-00006.
To evaluate the potential for limb salvage using the Ilizarov method to simultaneously treat bone and soft-tissue defects of the leg without flap coverage.
Retrospective study.
Level I trauma centers at 4 academic university medical centers.
PATIENTS/PARTICIPANTS: Twenty-five patients with bone and soft-tissue defects associated with tibial fractures and nonunions. The average soft-tissue and bone defect after debridement was 10.1 (range, 2-25) cm and 6 (range, 2-14) cm respectively. Patients were not candidates for flap coverage and the treatment was a preamputation limb salvage undertaking in all cases.
Ilizarov and Taylor Spatial Frames used to gradually close the bone and soft-tissue defects simultaneously by using monofocal shortening or bifocal or trifocal bone transport.
Bone union, soft-tissue closure, resolution or prevention of infection, restoration of leg length equality, alignment, limb salvage.
The average time of compression and distraction was 19.7 (range, 5-70) weeks, and time to soft-tissue closure was 14.7 (range, 3-41) weeks. Bony union occurred in 24 patients (96%). The average time in the frame was 43.2 (range, 10-82) weeks. Lengthening at another site was performed in 15 patients. The average amount of bone lengthening was 5.6 (range, 2-11) cm. Final leg length discrepancy (LLD) averaged 1.2 (range, 0-5) cm. Use of the trifocal approach resulted in less time in the frame for treatment of large bone and soft-tissue defects. There were no recurrences of osteomyelitis at the nonunion site. All wounds were closed. There were no amputations. All limbs were salvaged.
The Ilizarov method can be successfully used to reconstruct the leg with tibial bone loss and an accompanying soft-tissue defect. This limb salvage method can be used in patients who are not believed to be candidates for flap coverage. One also may consider using this technique to avoid the need for a flap. Gradual closure of the defect is accomplished resulting in bony union and soft-tissue closure. Lengthening can be performed at another site. A trifocal approach should be considered for large defects (>6 cm). Advances in technique and frame design should help prevent residual deformity.
评估使用伊里扎洛夫方法在不进行皮瓣覆盖的情况下同时治疗小腿骨与软组织缺损以挽救肢体的可能性。
回顾性研究。
4所大学医学中心的一级创伤中心。
患者/参与者：25例伴有胫骨骨折和骨不连的骨与软组织缺损患者。清创术后平均软组织和骨缺损分别为10.1（范围2 - 25）厘米和6（范围2 - 14）厘米。患者不适合进行皮瓣覆盖，所有病例的治疗均为截肢前的肢体挽救措施。
使用伊里扎洛夫和泰勒空间框架，通过单焦点缩短或双焦点或三焦点骨搬运来逐渐同时闭合骨与软组织缺损。
骨愈合、软组织闭合、感染的消退或预防、下肢长度恢复相等、对线、肢体挽救。
加压和牵张的平均时间为19.7（范围5 - 70）周，软组织闭合时间为14.7（范围3 - 41）周。24例患者（96%）实现了骨愈合。使用框架的平均时间为43.2（范围10 - 82）周。15例患者在其他部位进行了延长。平均骨延长量为5.6（范围2 - 11）厘米。最终下肢长度差异（LLD）平均为1.2（范围0 - 5）厘米。三焦点方法用于治疗大的骨与软组织缺损时在框架内的治疗时间较短。骨不连部位无骨髓炎复发。所有伤口均已闭合。无截肢情况。所有肢体均得以挽救。
伊里扎洛夫方法可成功用于重建伴有胫骨骨缺损和软组织缺损的小腿。这种肢体挽救方法可用于那些被认为不适合进行皮瓣覆盖的患者。也可考虑使用该技术来避免皮瓣的需求。缺损得以逐渐闭合，实现骨愈合和软组织闭合。可在其他部位进行延长。对于大的缺损（＞6厘米）应考虑采用三焦点方法。技术和框架设计的进步应有助于防止残留畸形。
