Emara Khaled M, Allam Mohamed Farouk
Department of Orthopedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Trauma. 2008 Sep;65(3):685-91. doi: 10.1097/TA.0b013e3181569ecc.
Ilizarov technique is useful in the management of infected nonunions of the tibia. Its main drawback is the long duration of external fixation (EF) with marked patient discomfort. Several techniques have been described for early removal of EF to avoid this problem.
Between September 2000 and October 2001, a prospective study at a tertiary trauma center was performed. Thirty-three patients with infected nonunion of the tibial shaft were included. The eradication of infection was by debridement, followed by limb reconstruction using segment transport technique with Ilizarov EF system. When the transported segment reached the docking site, we offered the patients removal of EF, and replacement by intramedullary (I M) fixation with bone graft at the docking site. Advantages and risks were explained to all patients. Patients (N = 17) who accepted this technique were compared with patients (N = 16) who preferred to continue in EF till full bone union, with bone graft at the docking site used in both groups. Mean age of the patients was 29 years, and mean duration of nonunion was 12.6 (range, 6-22) months. Average duration of follow-up from the date of presentation was 36 (range, 22-48) months. Main outcome measurements were assessment of bone and functional outcome using the classification of the Association for the Study and Application of the Method of Ilizarov, EF index, radiographic consolidation index, healing time, duration of EF, and complications
The average duration of EF in the first group was 3.1 month, meanwhile in the second group it was 8.5 months. The Association for the Study and Application of the Method of Ilizarov bony and functional outcome assessment score showed no statistically significant difference between the two techniques on follow-up.
Early removal of EF and replacement by intramedullary nail can achieve complete healing for infected nonunion of the tibial shaft with shorter duration of EF; nearly one-third the usual duration of EF and give the same functional and bony outcome as the classic technique. It is a relatively safe technique but the risk of infection recurrence must be explained to the patient.
伊里扎洛夫技术在治疗胫骨感染性骨不连方面很有用。其主要缺点是外固定时间长，患者明显不适。已经描述了几种早期去除外固定以避免此问题的技术。
2000年9月至2001年10月，在一家三级创伤中心进行了一项前瞻性研究。纳入33例胫骨干感染性骨不连患者。通过清创术根除感染，随后使用伊里扎洛夫外固定系统的节段性骨搬运技术进行肢体重建。当搬运的节段到达对接部位时，我们为患者提供去除外固定，并在对接部位用带骨移植的髓内固定进行替代。向所有患者解释了优点和风险。将接受该技术的患者（n = 17）与倾向于继续外固定直至完全骨愈合的患者（n = 16）进行比较，两组均在对接部位使用骨移植。患者的平均年龄为29岁，骨不连的平均持续时间为12.6（范围6 - 22）个月。从就诊日期起的平均随访时间为36（范围22 - 48）个月。主要结局指标是使用伊里扎洛夫方法研究与应用协会的分类评估骨和功能结局、外固定指数、影像学愈合指数、愈合时间、外固定持续时间和并发症。
第一组的平均外固定时间为3.1个月，而第二组为8.5个月。伊里扎洛夫方法研究与应用协会的骨和功能结局评估评分显示，两种技术在随访时无统计学显著差异。
早期去除外固定并用髓内钉替代可使胫骨干感染性骨不连实现完全愈合，外固定时间更短；几乎是通常外固定时间的三分之一，并且与经典技术具有相同的功能和骨结局。这是一种相对安全的技术，但必须向患者解释感染复发的风险。
