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[假关节]

[Pseudarthroses].

作者信息

Jäger Marcus, Wassenaar Dennis, Busch André, Haversath Marcel

机构信息

Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim an der Ruhr GmbH (Contilia), Kaiserstr. 50, 45468, Mülheim/Ruhr, Deutschland.

Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.

出版信息

Orthopade. 2020 Jun;49(6):547-560. doi: 10.1007/s00132-020-03920-w.

Abstract

Fractures and osteotomies are characterized by a structural discontinuity of the affected bone with formation of a gap. If bone healing does not lead to an osseous bridging of the fragments within a time period of 6 months a nonunion (pseudarthrosis) occurs. In this stage spontaneous bone healing is unlikely in the future without any intervention. Pseudarthrosis is classified into hypertrophic and atrophic types. Moreover, the differentiation between aseptic and septic conditions, the size of the defect, the local blood supply and the mechanical stability are crucial for treatment planning. The type of pseudarthrosis and the accompanying comorbidities can be classified in scoring systems and influence the selection of the treatment procedure. The operative principles aim at the vitalization of atrophic bone parts, achieving sufficient stabilization and cures the infection, whereas nonoperative measures are primarily supportive measures. The foundation of successful treatment is the minimization of individual risk profiles and sufficient patient compliance.

摘要

骨折和截骨术的特点是受影响的骨骼出现结构连续性中断并形成间隙。如果在6个月的时间段内骨愈合未导致骨折碎片的骨性桥接,则会发生骨不连(假关节)。在此阶段,如果不进行任何干预,未来自发骨愈合的可能性不大。假关节分为肥大性和萎缩性类型。此外,无菌和感染情况的区分、缺损大小、局部血供和机械稳定性对于治疗方案的制定至关重要。假关节的类型及伴随的合并症可通过评分系统进行分类,并影响治疗方法的选择。手术原则旨在使萎缩的骨部位恢复活力,实现充分稳定并治愈感染,而非手术措施主要是支持性措施。成功治疗的基础是将个体风险因素降至最低并确保患者有足够的依从性。

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