Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria.
Arch Orthop Trauma Surg. 2013 Jun;133(6):789-95. doi: 10.1007/s00402-013-1712-y. Epub 2013 Mar 5.
The treatment of large posttraumatic tibial bone defects using the Ilizarov method was shown to be successful in several studies. These studies, however, typically focus on the radiological and functional outcome using objective parameters only. The aim of the present study was therefore to assess the objective and subjective outcome of a consecutive series of patients with large posttraumatic tibial bone defects using the Ilizarov method. Additionally, it was our goal to assess the physical and mental stress for the patients and their relatives during the long treatment period and the general health status at final follow-up.
A consecutive series of 15 patients with posttraumatic tibial bone defects of >30 mm after sustaining open tibial fractures and failure of internal fixation was included. The objective outcome was assessed at final follow-up using Paley's criteria. For the assessment of the subjective outcome, all patients were asked to evaluate their satisfaction with the function of the lower leg, the cosmetic appearance and overall outcome as well. The physical and mental stress of the treatment for the patients and the nearest relative of patients were assessed at the time of frame removal using a custom-made questionnaire. The SF-36 was used to evaluate the general health status at final follow-up.
Solid bone union with stable soft tissue coverage and eradication of infection was achieved in all patients despite a high complication rate. The functional outcome at final follow-up was excellent or good in all patients. The patients' satisfaction with the overall outcome and the function of the lower extremity was high as well. The fear of amputation and complications was the major subjective burden for both the patients and their relatives. The long external fixation time is another relevant issue.
The Ilizarov method is a safe option for the treatment of large posttraumatic tibial bone defects after failure of internal fixation despite the high complication rate. It is essential to comment this to the patients and their relatives prior to the application of the frame increase their compliance with the long and emotionally draining treatment. The Ilizarov method is worth the effort only in patients, who will presumably comply with this treatment option and all of its drawbacks.
多项研究表明，伊里扎洛夫（Ilizarov）方法治疗外伤性胫骨大骨缺损是成功的。然而，这些研究通常仅使用客观参数来评估放射学和功能结果。因此，本研究旨在使用伊里扎洛夫（Ilizarov）方法评估一系列大外伤性胫骨骨缺损患者的客观和主观结果。此外，我们的目标是评估患者及其亲属在长期治疗期间的身体和精神压力以及最终随访时的整体健康状况。
本研究纳入了 15 例因开放性胫骨骨折和内固定失败导致>30mm外伤性胫骨骨缺损的患者。使用 Paley 标准评估最终随访时的客观结果。为了评估主观结果，所有患者都被要求评估他们对小腿功能、外观和整体结果的满意度。在去除外固定架时，使用定制的问卷评估患者及其最近亲属的治疗身体和精神压力。在最终随访时使用 SF-36 评估整体健康状况。
尽管并发症发生率高，但所有患者均实现了稳定的软组织覆盖和感染根除的骨愈合。所有患者在最终随访时的功能结果均为优或良。患者对整体结果和下肢功能的满意度也很高。对截肢和并发症的恐惧是患者及其亲属的主要主观负担。长时间的外固定也是一个相关问题。
尽管并发症发生率高，但伊里扎洛夫（Ilizarov）方法是治疗内固定失败后大外伤性胫骨骨缺损的安全选择。在应用外固定架之前，必须向患者及其亲属说明这一点，以提高他们对长期且情绪紧张的治疗的依从性。只有在预计会遵守这种治疗选择及其所有缺点的患者中，伊里扎洛夫（Ilizarov）方法才是值得的。
