Department of Trauma and Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, United Kingdom.
Department of Trauma and Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, United Kingdom.
Injury. 2019 Jun;50 Suppl 1:S73-S78. doi: 10.1016/j.injury.2019.03.053. Epub 2019 Mar 29.
External fixation is currently used as the definitive mode of fracture stabilisation in the management of ˜50% of long-bone non-unions. Distinction between non-union and delayed union is a diagnostic dilemma especially in fractures healing by primary bone repair. This distinction is important, as non-unions are not necessarily part of the same spectrum as delayed unions. The aetiology of a fracture non-union is usually multifactorial and the factors can be broadly categorized into mechanical factors, biological (local and systemic) factors, and infection. Infection is present in ˜40% of fracture non-unions, often after open fractures or impaired wound healing, but in 5% of all non-unions infection is present without any clinical or serological suspicion. General indications for external fixation include clinical scenarios where; 1) percutaneous correction of alignment, or mechanical stimulation of the non-union site is required; 2) fixation of juxta-articular or 'emmental' bone fragments is necessary; and 3) staged bone or soft tissue reconstruction is anticipated. Specific anatomical indications include infected non-unions of the tibia, humerus, and juxta-articular bone. External fixation is an essential tool in the management of fracture non-unions. However, with greater understanding of the outcomes associated with both external and internal fixation the relative indications are now being refined.
目前，外固定架被用作治疗 ˜50%长骨骨不连的主要骨折稳定方式。在原发性骨修复愈合的骨折中，尤其是在区分骨不连和延迟愈合时，这是一个诊断难题。这种区别很重要，因为骨不连不一定与延迟愈合属于同一范畴。骨折不连的病因通常是多因素的，这些因素可以大致分为机械因素、生物因素（局部和全身）和感染。感染见于 ˜40%的骨折不连，通常发生在开放性骨折或伤口愈合不良后，但在所有不连中，有 5%的感染没有任何临床或血清学怀疑。外固定架的一般适应证包括：1）需要经皮矫正对线或对不连部位进行机械刺激；2）需要固定关节旁或“骨突”骨碎片；3）预期进行分期骨或软组织重建。具体的解剖适应证包括感染性胫骨、肱骨和关节旁骨不连。外固定架是治疗骨折不连的重要工具。然而，随着对外固定和内固定相关结果的认识不断加深，其相对适应证正在不断得到精细化。
