Young J W, Kostrubiak I S, Resnik C S, Paley D
Department of Diagnostic Radiology, University of Maryland Medical System/Hospital, Baltimore 21201.
AJR Am J Roentgenol. 1990 Jan;154(1):125-8. doi: 10.2214/ajr.154.1.2104695.
The success of the Ilizarov distraction technique has resulted in a marked increase in the number of limb-lengthening and limb-straightening procedures performed for the correction of short and deformed limbs. This technique involves fracture of the bone and application of an external ring and bar support frame with circumferential screw threads and nuts, which allows systematic distraction of bone segments at a rate of 0.25 mm four times a day. During the procedure, the patient is encouraged to be ambulatory, as the strength of the frame allows weight bearing. Because of the limitations of plain radiographs in detecting the small amounts of new bone formation that occur at the distraction site in the early stages of healing, the success of the procedure cannot be determined for many weeks. The rate of distraction depends on the successful production of new bone in the distraction site. Early evaluation of new bone production is therefore important, because slow bone formation requires a decrease in distraction rate and vice versa. We examined 12 patients who had limb-lengthening procedures via the Ilizarov technique to determine if sonography could be used to detect early new bone formation at the distraction site. Our results show that new bone formation could be detected with sonography many weeks before its appearance on the radiograph. The sonographic appearance of new bone consists of echogenic foci within the distraction site, which become aligned in the longitudinal plane and which increase in number and size until they coalesce as echodense bone, which does not allow through-transmission of the ultrasound beam. In addition, sonograms showed 1.5-cm and 2-cm cysts within the distraction site in two patients in whom they were not visible on the radiographs. Timely percutaneous aspiration allowed continued normal bone generation. We conclude that sonography is useful for the detection of new bone formation at the distraction site in patients undergoing the Ilizarov procedure.
伊里扎洛夫牵张技术的成功使得用于矫正短小和畸形肢体的肢体延长及肢体矫直手术的数量显著增加。该技术包括骨折以及应用带有圆周螺纹和螺母的外环和杆支撑框架，这使得骨段能够以每天四次、每次0.25毫米的速率进行系统性牵张。在手术过程中，鼓励患者行走，因为框架的强度允许负重。由于普通X线片在检测愈合早期牵张部位少量新骨形成方面存在局限性，该手术的成功与否在数周内无法确定。牵张速率取决于牵张部位新骨的成功生成。因此，早期评估新骨生成很重要，因为骨形成缓慢需要降低牵张速率，反之亦然。我们检查了12例通过伊里扎洛夫技术进行肢体延长手术的患者，以确定超声检查是否可用于检测牵张部位的早期新骨形成。我们的结果表明，超声检查能够在新骨在X线片上出现的数周前检测到新骨形成。新骨的超声表现为牵张部位内的强回声灶，这些强回声灶在纵向上排列，数量和大小不断增加，直至融合成不允许超声束穿透的致密骨。此外，超声检查在两名患者的牵张部位显示出1.5厘米和2厘米的囊肿，而这些囊肿在X线片上不可见。及时进行经皮抽吸可使骨生成继续正常进行。我们得出结论，超声检查对于检测接受伊里扎洛夫手术患者牵张部位的新骨形成很有用。
