Khan Muhammad Shahid, Rashid Haroon, Umer Masood, Qadir Irfan, Hafeez Kamran, Iqbal Arshad
Department of Orthopaedic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
J Orthop Surg (Hong Kong). 2015 Apr;23(1):52-5. doi: 10.1177/230949901502300112.
To review outcomes of 24 patients who underwent Ilizarov ring fixation for infected nonunion of the tibia.
Medical records of 21 men and 3 women aged 13 to 74 (mean, 38) years who underwent Ilizarov ring fixation for infected non-union of the tibia were reviewed. The mean bone defect was 3.3 (range, 2-5) cm. The mean time from injury to presentation was 11.9 (range, 1-36) months. The mean number of previous surgeries was 2 (range, 0-14). A local flap was used in 2 patients and a free flap was used in one patient. Nine of the patients underwent Ilizarov ring fixation without soft tissue and bony resection, as inadequate stability was the reason for non-union. Patients were assessed using the Association for the Study and Application of the Method of Ilizarov criteria.
Patients were followed up for a mean of 11 (range, 8-46) months. Functional outcome was excellent in 8 patients, good in 12, fair in 2, and failure in one, whereas bone union outcome was excellent in 6 patients, good in 14, fair in one, and poor in 2. The mean time to union was 8 (range, 3-31) months. The mean external fixation index was 4.2 (range, 1.5-15.7) cm/month. Complications encountered were pin tract infection (n=5), re-fracture (n=2), soft tissue impingement by Ilizarov rings (n=2), recurrence of wound infection (n=1), mal-union (n=1), and mortality (n=1).
Ilizarov ring fixation is a viable option for infected non-union of the tibia. Adequate assessment of bone union is crucial before removal of fixator to prevent re-fracture.
回顾24例接受Ilizarov环形固定治疗胫骨感染性骨不连患者的治疗结果。
回顾21例男性和3例女性患者的病历，年龄在13至74岁（平均38岁），均接受Ilizarov环形固定治疗胫骨感染性骨不连。平均骨缺损为3.3（范围2 - 5）厘米。从受伤到就诊的平均时间为11.9（范围1 - 36）个月。既往手术的平均次数为2（范围0 - 14）次。2例患者采用局部皮瓣，1例患者采用游离皮瓣。9例患者在未进行软组织和骨切除的情况下接受Ilizarov环形固定，因为稳定性不足是骨不连的原因。使用Ilizarov方法研究与应用协会的标准对患者进行评估。
患者平均随访11（范围8 - 46）个月。功能结果：8例优秀，12例良好，2例一般，1例失败；骨愈合结果：6例优秀，14例良好，1例一般，2例差。平均愈合时间为8（范围3 - 31）个月。平均外固定指数为4.2（范围1.5 - 15.7）厘米/月。出现的并发症包括针道感染（n = 5）、再骨折（n = 2）、Ilizarov环对软组织的压迫（n = 2）、伤口感染复发（n = 1）、畸形愈合（n = 1）和死亡（n = 1）。
Ilizarov环形固定是治疗胫骨感染性骨不连的一种可行选择。在拆除固定器之前，对骨愈合进行充分评估对于预防再骨折至关重要。
