Khan Muhammad Shoaib, Awais Syed Muhammad
City Hospital, Peshawar.
J Ayub Med Coll Abbottabad. 2007 Jul-Sep;19(3):34-6.
Tibial bone defect lead to limb shortening and functional deficit and needs proper treatment. There are various treatment modalities for bone defect in long bone to restore length and function of the limb, i.e. bone grafting, vascularised bone graft, allograft and bone transport. Bone transport can be done through fixators (uniplaner or ring) and intramedullary nail system. This study was conducted on management of tibial non-union with Ilizarov external fixator.
This descriptive study was performed on 58 patients in Agency Headquarter Hospital, Bajawar and Lady Reading Hospital, Peshawar, from January 2000 to January 2006. Patients of either gender with age between 9 to 58 years, having nonunion (clean and infected nonunion) in tibia with defect of 2 to 7cm due to trauma or firearm injury were included in the study. These patients were followed up upto one year. Outcome measures were according to the classification of Association for the Study and Application of the Method of Ilizarov (ASAMI), which is based on radiological (defect filling) and clinical (functional) findings.
Out of 58 patients, 44 (75%) were male and 14 (25%) were female. Mean age was 30 years (9 to 58 years). 38 (65.52%) patients had infected non-union while 20 (34.48%) had clean non-union. Right tibia was involved in 32 patients (51.17%) and left was involved in 26 (44.83%) patients. The cause of initial trauma was road traffic accident in 27 patients (46.55%), firearm injury in 23 patients (39.65%) and a simple fall in 8 patients (13.79%). The length of average bone defect was 2.90 cm (200-7.00 cm). Radiological results were excellent in 33 (58.89%) patients, good in 12 (20.68%) patients, fair in 8 (13.79%) patients and poor in 5 (8.62%) patients. The clinical results were excellent in 33 patients (56.89%), good in 18 patients (31.05%), fair in 4 (6.89%) patients and poor in 3 patients (5.17%).
Ilizarov ring fixator is excellent treatment modality for tibial non-union with a defect, regarding bone union, deformity correction, infection eradication, limb length achievement and limb function but this needs prolonged learning curve for fresh orthopedic surgeons.
胫骨骨缺损会导致肢体短缩和功能障碍，需要恰当的治疗。长骨骨缺损有多种治疗方式来恢复肢体长度和功能，即骨移植、带血管蒂骨移植、同种异体骨移植和骨搬运。骨搬运可通过外固定架（单平面或环形）和髓内钉系统进行。本研究针对使用伊里扎洛夫外固定架治疗胫骨骨不连展开。
本描述性研究于2000年1月至2006年1月在巴贾瓦尔军区总部医院和白沙瓦雷丁夫人医院对58例患者进行。纳入研究的患者年龄在9至58岁之间，性别不限，因创伤或火器伤导致胫骨骨不连（清洁性和感染性骨不连）且骨缺损2至7厘米。对这些患者进行了长达一年的随访。结局指标依据伊里扎洛夫方法研究与应用协会（ASAMI）的分类标准，该标准基于放射学（骨缺损填充情况）和临床（功能）表现。
58例患者中，44例（75%）为男性，14例（25%）为女性。平均年龄为30岁（9至58岁）。38例（65.52%）患者为感染性骨不连，20例（34.48%）为清洁性骨不连。右侧胫骨受累的患者有32例（51.17%），左侧受累的患者有26例（44.83%）。初始创伤的原因是道路交通事故的患者有27例（46.55%），火器伤的患者有23例（39.65%），单纯跌倒的患者有8例（13.79%）。平均骨缺损长度为2.90厘米（2.00 - 7.00厘米）。放射学结果为优的患者有33例（58.89%），良的患者有12例（20.68%），可的患者有8例（13.79%），差的患者有5例（8.62%）。临床结果为优的患者有33例（56.89%），良的患者有18例（31.05%），可的患者有4例（6.89%），差的患者有3例（5.17%）。
对于伴有骨缺损的胫骨骨不连，伊里扎洛夫环形外固定架在骨愈合、畸形矫正、感染根除、肢体长度恢复和肢体功能方面是一种出色的治疗方式，但对于新晋骨科医生而言，这需要较长的学习曲线。
