Bhowmick Kaushik, Boopalan P R J V C, Gunasekeran Chandrasekaran, Livingston Abel, Jepegnanam Thilak Samuel
Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India.
J Knee Surg. 2020 Feb;33(2):213-222. doi: 10.1055/s-0038-1677512. Epub 2019 Jan 16.
Infected nonunion and malunion of tibial plateau are rare injuries with no standardized protocols for treatment. This study assessed the outcome of chronic infected intra-articular proximal tibial fractures with and without metaphyseal bone loss managed with the Ilizarov ring fixator. A series of six patients of intra-articular infected nonunion of the tibial plateau and two patients with malunited plateau with metaphyseal nonunion were treated in a tertiary care hospital. Three of these eight patients had a metaphyseal bone loss or bone gap after debridement and underwent internal transport with distal corticotomy to obtain the bone length. The remaining five patients underwent static ring fixation after correction of the articular deformity. Clinical evaluation was done by Knee Society Score, Rasmussen radiological and Association for the Study and Application of Methods of Ilizarov scores. All patients but one achieved union with the ring fixator. The average follow-up was 33 months (range, 12-120 months). Average time to achieve union was 11.5 months (range, 3-30). The scores were good in four patients and poor in the rest four, out of which three had undergone internal transport. Proximal tibia intra-articular infected nonunion and malunion with or without metaphyseal bone loss can be treated successfully with the Ilizarov fixator. Malunion of the tibial plateau has to be addressed in cases with varus alignment of the limb or articular step-off of ≥ 5mm between the two tibial surfaces. Patients with associated metaphyseal bone loss tend to have complications and take a longer duration to heal. Single-stage treatment avoids intra-articular malunion and loss of limb alignment.
胫骨平台感染性骨不连和畸形愈合是罕见损伤，目前尚无标准化治疗方案。本研究评估了采用伊利扎罗夫环形固定器治疗的伴有和不伴有干骺端骨质缺损的慢性感染性胫骨近端关节内骨折的疗效。一家三级护理医院对6例胫骨平台关节内感染性骨不连患者和2例伴有干骺端骨不连的畸形愈合患者进行了治疗。这8例患者中有3例在清创后出现干骺端骨质缺损或骨间隙，接受了远端截骨术的骨内移位以获得骨长度。其余5例患者在矫正关节畸形后接受了静态环形固定。通过膝关节协会评分、拉斯穆森影像学评分以及伊利扎罗夫方法研究与应用协会评分进行临床评估。除1例患者外，所有患者均通过环形固定器实现了骨愈合。平均随访时间为33个月（范围12 - 120个月）。实现骨愈合的平均时间为11.5个月（范围3 - 30个月）。4例患者评分良好，其余4例评分较差，其中3例接受了骨内移位。伴有或不伴有干骺端骨质缺损的胫骨近端关节内感染性骨不连和畸形愈合可用伊利扎罗夫固定器成功治疗。对于肢体呈内翻畸形或两胫骨面之间关节台阶≥5mm的胫骨平台畸形愈合病例，必须进行处理。伴有干骺端骨质缺损的患者往往会出现并发症，愈合时间较长。一期治疗可避免关节内畸形愈合和肢体对线丢失。
