Seybold Dominik, Gessmann Jan, Ozokyay Levent, Frangen Thomas, Muhr Gert, Graf Markus
Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum, Ruhr-Universität Bochum, Bochum, Germany.
Langenbecks Arch Surg. 2009 Mar;394(2):393-8. doi: 10.1007/s00423-008-0351-1. Epub 2008 May 31.
Fracture care in obese patients is becoming an everyday problem because the prevalence of obesity in European countries has tripled since the last 20 years.
With the use of a custom made Ilizarov ring fixator with a ring diameter of 300 to 340 mm, fracture stabilization in three morbidly obese patients was performed. The patients' body mass index (BMI) ranged from 59 to 89. There were one proximal tibia fracture and two pilon fractures. The tibia fracture was stabilized with a 340-mm frame and the pilon fractures were stabilized by primary ankle arthrodesis with 300-mm frames. Primary ankle arthrodesis was performed because polyneuropathy and Charcot arthropathy were present in one patient and in the other patient because time from injury to referral was too long for reconstruction.
All patients were able to fully weight bear. Frame removal after fracture correction and consolidation was performed only in the patient with the tibial fracture (patient BMI 89). The other patients died during the treatment because of decompensated comorbidities.
The Ilizarov technique is a good fixation modality for stabilizing fractures of the lower limb in morbidly obese patients. Associated medical comorbidities are the limitations of successful fracture care.
由于欧洲国家肥胖症的患病率在过去20年里增长了两倍，肥胖患者的骨折治疗正成为一个日常问题。
使用定制的直径为300至340毫米的伊里扎洛夫环形固定器，对三名病态肥胖患者进行骨折固定。患者的体重指数（BMI）在59至89之间。有一例胫骨近端骨折和两例pilon骨折。胫骨骨折用340毫米的框架固定，pilon骨折通过用300毫米的框架进行一期踝关节融合术固定。进行一期踝关节融合术的原因是，一名患者存在多发性神经病和夏科关节病，另一名患者则是因为从受伤到转诊的时间过长，无法进行重建。
所有患者均能够完全负重。仅对胫骨骨折患者（患者BMI为89）在骨折矫正和巩固后拆除了固定架。其他患者在治疗期间因合并症失代偿而死亡。
伊里扎洛夫技术是稳定病态肥胖患者下肢骨折的一种良好固定方式。相关的内科合并症是成功治疗骨折的限制因素。
