Pinzur Michael S
Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA.
Foot Ankle Clin. 2006 Dec;11(4):837-47. doi: 10.1016/j.fcl.2006.06.006.
These two morbidly obese patients with severe Charcot foot arthropathy were treated successfully with percutaneous correction of their deformity followed by a stepwise application of a pre-assembled neutrally aligned multiplane ring external fixator. This technique transfers well to the trauma environment in which alignment can be maintained without further violation within the zone of injury. The application of the fine wire ring external fixation has been used for many years to accomplished leg lengthening and correction of deformity. Historically it has required a great deal of experience to apply to complex frames and implement the required daily adjustments. The patient experience often has been an unpleasant ordeal with a high potential for associated morbidity. This negative exposure has prompted practicing orthopedic surgeons to avoid this technique, feeling that it best be left to those in tertiary care setting who are equipped to handle the morbidity and complications. Taking this technology from the domain of the deformity surgeon to the general orthopedic community will require the suppression of bad memories from residency. Using the device solely as a method of maintaining alignment eliminates many of the dynamic attributes that contributes to pain and morbidity. The bone and soft tissues are not stretched, eliminating much of the pain and decreasing the rate of traction-associated pin tract morbidity. Because there is no dynamic of the treatment, the simplified frame can be pre-assembled and have no adjustable components. The experience derived from this application has the potential of expanding the role of ring external fixation. Where the ring has been used previously as method of both obtaining and maintaining alignment, this application uses a simplified neutral version of a complex device to simply maintain alignment in a high risk patient population. Correction of deformity and achieving alignment/reduction of fractures is well within the domain of practicing orthopedic surgeon. Once that correction has been achieved, this application simply maintains that correction. It helps avoid extensive surgical dissection in a poor host and eliminates the need for bone that is mechanically capable of holding internal fixation devices during the bony and soft tissue healing period.
这两名患有严重夏科氏足关节病的病态肥胖患者，通过经皮矫正畸形，随后逐步应用预组装的中立对齐多平面环形外固定器，获得了成功治疗。该技术能很好地应用于创伤环境，在这种环境中可保持对线，而不会在损伤区域内造成进一步破坏。细钢丝环形外固定的应用多年来一直用于实现肢体延长和畸形矫正。从历史上看，将其应用于复杂框架并进行所需的日常调整需要大量经验。患者的体验往往是一场不愉快的折磨，且伴有较高的相关发病率风险。这种负面情况促使骨科医生避免使用该技术，认为最好留给那些具备处理相关发病率和并发症能力的三级医疗机构的医生。将这项技术从畸形矫正外科医生的领域推广到普通骨科领域，需要消除住院医师培训期间留下的不良记忆。仅将该装置用作维持对线的方法，就消除了许多导致疼痛和发病率的动态因素。骨骼和软组织不会被拉伸，从而消除了大部分疼痛，并降低了牵引相关的针道发病率。由于治疗过程没有动态变化，简化后的框架可以预先组装，且没有可调节部件。从该应用中获得的经验有可能扩大环形外固定的作用。以前环形外固定既用于获得对线也用于维持对线，而本应用使用一种复杂装置的简化中立版本，仅在高风险患者群体中维持对线。畸形矫正以及实现骨折的对线/复位完全属于执业骨科医生的范畴。一旦实现了矫正，本应用只需维持该矫正状态。它有助于避免在条件较差的患者身上进行广泛的手术解剖，并且在骨和软组织愈合期间无需使用能够固定内固定装置的机械性能良好的骨骼。
