Center for Ilizarov Techniques, Chaudhary Hospital, Akola, India.
Center for Ilizarov Techniques, Akola, India.
Bone Joint J. 2019 Feb;101-B(2):178-188. doi: 10.1302/0301-620X.101B2.BJJ-2018-0622.R1.
Double-level lengthening, bone transport, and bifocal compression-distraction are commonly undertaken using Ilizarov or other fixators. We performed double-level fixator-assisted nailing, mainly for the correction of deformity and lengthening in the same segment, using a straight intramedullary nail to reduce the time in a fixator.
A total of 23 patients underwent this surgery, involving 27 segments (23 femora and four tibiae), over a period of ten years. The most common indication was polio in ten segments and rickets in eight; 20 nails were inserted retrograde and seven antegrade. A total of 15 lengthenings were performed in 11 femora and four tibiae, and 12 double-level corrections of deformity without lengthening were performed in the femur. The mean follow-up was 4.9 years (1.1 to 11.4). Four patients with polio had tibial lengthening with arthrodesis of the ankle. We compared the length of time in a fixator and the external fixation index (EFI) with a control group of 27 patients (27 segments) who had double-level procedures with external fixation. The groups were matched for the gain in length, age, and level of difficulty score.
The mean gain in length was statistically similar in the two groups: 3.9 cm (1.5 to 9.0) in the study group and 4.2 cm (3.4 to 5.0) in the control group (p = 0.350). The mean time in a fixator was significantly less in the study group compared with the control group: 8.6 weeks (2.0 to 22.8) versus 30.2 weeks (25.0 to 35.4; p < 0.001). The mean EFI was significantly lower in the study group compared with the control group: 17.7 days/cm (10.6 to 35.6) versus 73.4 days/cm (44.5 to 102.3; p < 0.001). The ASAMI (Association for the Study and Application of the Method of Ilizarov) bone score was excellent in 22, good in four, and fair in one. The ASAMI functional score was excellent in 20 and good in seven. There were no infections, superficial or deep.
Double-level osteotomies or two procedures using a custom-made straight nail and external fixation can be used to correct deformities or to treat nonunion or malunion and may be combined with arthrodesis of the ankle with lengthening. It is a reasonably safe procedure that allows accurate and cost-effective treatment with a relatively short time in a fixator.
双平面延长、骨搬运和双焦点压缩-牵张通常使用伊利扎洛夫（Ilizarov）或其他外固定器进行。我们使用直髓内钉进行双平面固定器辅助钉治疗，主要用于同一节段的畸形矫正和延长，以减少外固定器的使用时间。
共有 23 名患者接受了这种手术，涉及 27 个节段（23 个股骨和 4 个胫骨），历时 10 年。最常见的适应症是 10 个节段的小儿麻痹症和 8 个节段的佝偻病；20 个钉子逆行插入，7 个钉子顺行插入。11 个股骨和 4 个胫骨共进行了 15 次延长，12 个股骨进行了双平面畸形矫正而无需延长。平均随访时间为 4.9 年（1.1 至 11.4 年）。4 名小儿麻痹症患者行胫骨延长伴踝关节融合术。我们将 27 名（27 个节段）接受双平面外固定术的患者作为对照组，比较了固定器使用时间和外固定指数（EFI）。两组在延长长度、年龄和难度评分方面相匹配。
两组的平均延长长度差异无统计学意义：研究组为 3.9cm（1.5 至 9.0），对照组为 4.2cm（3.4 至 5.0）（p=0.350）。与对照组相比，研究组固定器使用时间明显缩短：8.6 周（2.0 至 22.8）与 30.2 周（25.0 至 35.4；p<0.001）。与对照组相比，研究组的平均 EFI 明显降低：17.7 天/cm（10.6 至 35.6）与 73.4 天/cm（44.5 至 102.3；p<0.001）。ASAMI（伊利扎洛夫方法研究与应用协会）骨评分优秀 22 例，良好 4 例，可 1 例。ASAMI 功能评分优秀 20 例，良好 7 例。无感染，包括浅表和深部感染。
双平面截骨或使用定制直钉和外固定器进行两次手术可矫正畸形或治疗骨不连或畸形愈合，并可与踝关节融合术联合延长。这是一种合理安全的手术方法，可通过相对较短的固定器使用时间实现准确、经济有效的治疗。
