Dróżdż Marek, Rak Stanisław, Bartosz Paweł, Białecki Jerzy, Marczyński Wojciech
Orthopaedics Department, Postgraduate Medical Education Centre, Bone and Joint Infection Ward , Independent Public Research Hospital, Otwock, Poland.
Ortop Traumatol Rehabil. 2017 Apr 12;19(2):111-125. doi: 10.5604/15093492.1237999.
Infected nonunion is a complex complication of the treatment of long bone fractures. An in creased incidence of injuries, including high energy injuries (often open ones), contributes to a higher incidence of nonunion. These primarily infected injuries cause osteomyelitis, which prevents bone union, resulting in an infected nonunion. The Ilizarov method meets the biological and biomechanical treatment requirements, opti mising the process of inflammation healing and producing bone union.
A total of 54 patients were treated in 2000-2014 for nonunion in the lower limbs with the Ilizarov method, which was used after previous treatment had failed. The subjects underwent intra operative resection of the locus of infection, sequestrectomy and a Judet procedure, followed by the use of the Ilizarov apparatus and bone transport, depending on the defect.
Inflammation healed in 52 patients (96%) and bone union was achieved in 46 patients (86%). Good outcomes with healed inflammation and bone union were reported in 76% of the cases, fair outcomes with tem porary elimination of the inflammation and without bone union in 16%, and poor outcomes without inflam ma tion healing and without bone union in 7%.
Treatment of infected nonunion can only be effective after eliminating endogenous inflamma tory foci, covering skin defects, ensuring a good condition of the skin and soft tissues, restoring normal blood supply to the bone fragments, and good biomechanical fixation of the fragments with dynamisation or compression. The Ilizarov method is a method of choice in the treatment of cases of infected nonunion where other treatments have failed.
感染性骨不连是长骨骨折治疗中的一种复杂并发症。包括高能损伤（通常为开放性损伤）在内的损伤发生率增加，导致骨不连的发生率更高。这些主要为感染性损伤会引发骨髓炎，从而阻碍骨愈合，导致感染性骨不连。伊里扎洛夫方法满足生物学和生物力学治疗要求，优化炎症愈合过程并实现骨愈合。
2000年至2014年期间，共有54例下肢骨不连患者采用伊里扎洛夫方法治疗，该方法在先前治疗失败后使用。患者接受了感染部位的术中切除、死骨切除术和儒代手术，随后根据缺损情况使用伊里扎洛夫器械并进行骨搬运。
52例患者（96%）炎症愈合，46例患者（86%）实现骨愈合。76%的病例报告炎症愈合且骨愈合效果良好；16%的病例炎症暂时消除但未实现骨愈合，效果尚可；7%的病例炎症未愈合且未实现骨愈合，效果较差。
只有在消除内源性炎症病灶、覆盖皮肤缺损、确保皮肤和软组织状况良好、恢复骨碎片正常血供以及通过动力化或加压对碎片进行良好的生物力学固定后，感染性骨不连的治疗才可能有效。在其他治疗方法失败的感染性骨不连病例中，伊里扎洛夫方法是首选治疗方法。
