Baruah Ranjit Kr
Department of Orthopedics, Assam Medical College, Dibrugarh - 786 002, Assam, India.
Indian J Orthop. 2007 Jul;41(3):198-203. doi: 10.4103/0019-5413.33682.
Conventional wire fixation of Ilizarov rings often fails to provide 90-90 configuration because of vital structures, which is essential for optimum stability. Hybrid assembly with half pins is an alternative. The aim of this study is to compare the results of Hybrid assembly with that of conventional classic circular transfixion wire Ilizarov assembly in 50 cases of infected nonunion of tibia between 1994 and 2003.
This study includes two groups with 25 patients in each group: Group (A) conventional Ilizarov assembly and Group (B) hybrid Ilizarov assembly. Thirty-five cases developed infected nonunion following road traffic accidents while others after fall (6) bullet injury (4), infected osteosynthesis (3) and assault (2). There were 45 males and five females with mean age (18 to 56 years). All active cases (n=28) were treated by debridement including removal of implants in infected osteosynthesis. Twenty out of 22 cases in the quiescent group (non draining for last three consecutive months) were treated without open debridement; only two cases required open debridement for various reasons. All the cases were finally treated as atrophic aseptic nonunion with bone defect and were classified according to ASAMI. Type B1: length of the limb maintained with bone gap (14 cases in both Group A and B) and Type B3: combined shortening with defect (five and seven cases in Group A and B respectively), were treated by bifocal osteosynthesis. Only one case in the B3 group was treated by trifocal osteosynthesis to shorten the time. Type B2: segments in contact with limb shortening (total nine cases; five and four cases in Group A and B respectively) with shortening up to 2 cm (total five cases) were treated with monofocal osteosynthesis while shortening up to 5 cm and beyond (total four cases) were treated with bifocal osteosynthesis.
The cases were followed up for two to six years and the results were evaluated by Paley criteria of bony results (union, infection, deformity and leg-length discrepancy) and Functional Results (significant limp, equinus rigidity of the ankle, soft-tissue dystrophy, pain and inactivity). In both the groups, 24 cases out of 25, had excellent to good bony result with Group B having twice more excellent result than Group A. Functional results were found to be similar in both the groups. Although persistence of infection and Grade III pin tract infection (PTI) were slightly higher in Group B, complications like delayed consolidation of regenerate, refracture, deformity and aneurysm of vessel were less in this group.
Ilizarov methodology produced a satisfactory result in infected nonunion of the tibia. Hybrid assembly was a fruitful advancement in the Ilizarov armamentarium. The results were comparable to Conventional assembly in terms of docking site problems, corticotomy site problems, PTIs and other problems.
由于重要结构的存在，传统的伊里扎洛夫环形外固定器钢丝固定常常无法实现90-90构型，而这种构型对于达到最佳稳定性至关重要。采用半针的混合式组装是一种替代方法。本研究的目的是比较1994年至2003年间50例胫骨感染性骨不连患者中混合式组装与传统经典环形贯穿钢丝伊里扎洛夫组装的结果。
本研究包括两组，每组25例患者：A组为传统伊里扎洛夫组装，B组为混合式伊里扎洛夫组装。35例患者因道路交通事故后发生感染性骨不连，其他患者分别因跌倒（6例）、枪伤（4例）、感染性骨固定术（3例）和袭击（2例）。共有45例男性和5例女性，平均年龄在18至56岁之间。所有活动期病例（n = 28）均接受清创治疗，包括去除感染性骨固定术中的植入物。静止期组（连续三个月无引流）的22例患者中，20例未进行开放性清创治疗；仅2例因各种原因需要进行开放性清创。所有病例最终均被视为伴有骨缺损的萎缩性无菌性骨不连，并根据ASAMI进行分类。B1型：肢体长度得以维持但存在骨间隙（A组和B组各14例），B3型：伴有缺损的合并短缩（A组5例，B组7例），采用双焦点骨合成术治疗。B3组中仅1例采用三焦点骨合成术以缩短治疗时间。B2型：肢体短缩但节段接触（共9例；A组5例，B组4例），短缩达2 cm（共5例）采用单焦点骨合成术治疗，短缩达5 cm及以上（共4例）采用双焦点骨合成术治疗。
对病例进行了2至6年的随访，并根据佩利骨结果标准（骨愈合情况、感染情况、畸形情况和肢体长度差异）以及功能结果标准（明显跛行、踝关节马蹄足僵硬、软组织萎缩、疼痛和活动受限）对结果进行评估。两组中，25例患者中有24例获得了优良的骨结果，B组的优良结果数量是A组的两倍。发现两组的功能结果相似。虽然B组感染持续存在和III级针道感染（PTI）的发生率略高，但该组再生延迟愈合、再骨折、畸形和血管动脉瘤等并发症较少。
伊里扎洛夫方法在胫骨感染性骨不连的治疗中取得了令人满意的结果。混合式组装是伊里扎洛夫器械库中的一项富有成效的进展。在对接部位问题、截骨部位问题、PTI及其他问题方面，其结果与传统组装相当。
