Jovanović Vesna, Vukasinović Zoran, Seslija Igor, Zivković Zorica
Institute of Orthopaedic Surgery Banjica, Belgrade, Serbia.
Srp Arh Celok Lek. 2010 Sep-Oct;138(9-10):643-6. doi: 10.2298/sarh1010643j.
Septic pseudoarthroses of the tibia represent a relatively frequent complication of open fractures with a large soft tissue damage. They may be localized: in the proximal metaphysis, between the proximal and middle thirds, between middle and distal thirds, in the distal metaphysis.
A case of a 52-year-old man with open fracture of the left tibia is presented. He fell from the height of 30 meters. The external fixation according to Mitkovic was performed in another institution. The patient was referred to our hospital nine months after the accident, with clear clinical and radiological signs of septic pseudoarthrosis of the tibia. The resection of septic pseudoarthrosis was done two weeks after admission. Three weeks later, another operation was performed, bilocal alternating distractive-compressive osteosynthesis according to Ilizarov. After eleven months Ilizarov frame was removed, with clinical, radiological signs of healing of pseudoarthrosis and complete curing of the infection. Five months after removal of the frame, the patient was fully anatomically and functionally recovered.
Being satisfied with the achieved results and encouraged with the data from the literature, we recommend this method as the method of choice for the treatment of pseudoarthrosis of the tibia. The advantage consists of curing the infection using the natural bactericide power of the tissue and curing the bone defect, at the same time, and finally, producing the equalization of the legs.
胫骨感染性假关节是开放性骨折伴严重软组织损伤相对常见的并发症。其可位于:近端干骺端、近端与中段之间、中段与远端之间、远端干骺端。
本文介绍一例52岁男性左胫骨开放性骨折的病例。他从30米高处坠落。在另一家机构进行了米特科维奇式外固定。事故九个月后患者被转诊至我院,有明确的胫骨感染性假关节临床及影像学表现。入院两周后进行了感染性假关节切除术。三周后,根据伊里扎洛夫技术进行了二次手术,即双部位交替撑开-加压骨合成术。十一个月后拆除伊里扎洛夫外固定架,此时假关节有临床及影像学愈合表现且感染完全治愈。拆除外固定架五个月后,患者在解剖结构和功能上完全恢复。
鉴于对取得的结果感到满意且受到文献数据的鼓舞,我们推荐此方法作为治疗胫骨假关节的首选方法。其优点包括利用组织的天然杀菌能力治愈感染,同时治愈骨缺损,最终实现双下肢等长。