Department of Orthopaedic Surgery, Medical School, University of Patras, Patras, Greece.
Injury. 2010 Mar;41(3):294-9. doi: 10.1016/j.injury.2009.09.013.
The purpose of this study was to demonstrate the effectiveness of the Ilizarov method and circular external fixator in order to eradicate the infection and restore bone union, limb anatomy and functionality in cases with infected nonunion of the tibia following intramedullary nailing. During 7 years nine patients suffering from infected nonunion of the tibia after intramedullary nailing were treated in our department. The series comprised seven men and two women with an average age of 39.7 years (range 21-75 years). The patients had previously undergone an average of 4.8 operations (range 3-6 operations). Active purulent bone infection occurred in all nine patients. Bone defect was present in all patients with a mean size of 5 cm (range 2-12 cm). In three cases with bone defect less than 2 cm, monofocal compression osteosynthesis technique was used. In the rest cases where bone defect exceeded 2 cm, bifocal consecutive distraction-compression osteosynthesis technique was applied. Three patients required a local gastrocnemius flap. The mean follow-up period was 26.6 months (range 13-42 months). Results were evaluated using Paley's functional and radiological scoring system. Bone union was achieved in all nine patients without recurrence of infection during the follow-up period. Bone results were graded as excellent in five cases and good in the rest four cases. Functional results were graded as excellent in three cases, good in four and fare in two cases. Mean external fixation time was 187.4 days (range 89-412 days) and mean lengthening index was 32 days/cm (range 27-39 days/cm). Complications observed included eight grade II pin tract infections, axial deformity at the lengthening site in two cases and at the nonunion site in another two cases. Ankle joint stiffness was detected in five cases. The Ilizarov method may be an effective method in infected nonunions of the tibia following intramedullary nailing.
本研究旨在展示 Ilizarov 方法和环形外固定器在治疗髓内钉治疗胫骨感染性骨不连中的有效性，以消除感染并恢复骨愈合、肢体解剖结构和功能。在我们科，7 年来共治疗了 9 例髓内钉治疗后胫骨感染性骨不连患者。该系列包括 7 名男性和 2 名女性，平均年龄 39.7 岁（范围 21-75 岁）。所有患者均曾接受过平均 4.8 次手术（范围 3-6 次）。9 例患者均有急性化脓性骨感染。所有患者均存在骨缺损，平均大小为 5cm（范围 2-12cm）。在 3 例骨缺损小于 2cm 的病例中，采用单焦点压缩骨合成技术。在其余骨缺损大于 2cm 的病例中，采用双焦点连续牵张-压缩骨合成技术。3 例患者需要局部腓肠肌皮瓣。平均随访时间为 26.6 个月（范围 13-42 个月）。结果采用 Paley 功能和影像学评分系统进行评估。9 例患者均获得骨愈合，随访期间无感染复发。骨结果评为优秀 5 例，良好 4 例。功能结果评为优秀 3 例，良好 4 例，一般 2 例。外固定时间平均为 187.4 天（范围 89-412 天），平均延长指数为 32 天/cm（范围 27-39 天/cm）。观察到的并发症包括 8 例 II 级钉道感染、2 例延长部位轴向畸形和 2 例非愈合部位轴向畸形、5 例踝关节僵硬。在髓内钉治疗胫骨感染性骨不连中，Ilizarov 方法可能是一种有效的方法。
