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两阶段内固定治疗下肢外固定失败

Management of Failed External Fixation by Two-Staged Internal Osteosynthesis in the Lower Limb.

作者信息

Kornah Bahaa Ali, Abdelaziz Mohamed, I Abulsoud Mohamed, Abdel Ghani Tharwat, Seleem Nagi, Alshal Ehab A, Abdel-AAl Mohamed Aly

机构信息

Department of Orthopedics, Faculty of Medicine, AL-Azhar University, Cairo, Egypt.

Elbakry General Hospital, Ministry of Health, Cairo, Egypt.

出版信息

Orthop Surg. 2021 Apr;13(2):426-433. doi: 10.1111/os.12870. Epub 2021 Jan 19.

DOI:10.1111/os.12870
PMID:33470032
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7957394/
Abstract

OBJECTIVE

This study aims to evaluate the result of a two-stage (delayed conversion) management of nonunion after failed external fixation of the lower limb.

METHODS

A case series of 25 patients (19 males and six females) enrolled in this study between February 2008 and October 2016, mean age 33.4 years (range, 22-65 years). Eight had femoral fractures, and 17 had tibial fractures. All were due to high-energy trauma and were open fractures. All cases were presented by non-union after external fixation in the lower limb long bones. All patients were managed by two stages (delayed conversion) osteosynthesis. The patients have been assessed for rate and time for union, range of motion of adjacent joints, the Modified functional outcome score of Karlstrom-Olerud, and Trauma outcomes measure score.

RESULTS

The mean follow-up was 36.5 months (range 24-54 months). Twenty-two cases (88%) were fully united on an average of 5.3 months. According to the Karlstrom-Olerud scores, the final functional outcome score was excellent 12 cases, good 9 cases, accepted 2 cases, and poor in two cases. As regards the trauma outcome measure score, the mean TOM after 3 months was 26.1 (25.3-27.3), 30.4 (29.3-32.1) after 12 months, and 33.4 (32.3-40) after 24 months.

CONCLUSIONS

The technique of two-stage treatment of nonunions of long bone after external fixation is a successful tool to achieve bony union. It could be a favorable option with a low risk of complications and a high level of functional outcomes.

摘要

目的

本研究旨在评估下肢外固定失败后两阶段（延迟转换）治疗骨不连的结果。

方法

本病例系列研究纳入了2008年2月至2016年10月期间的25例患者（19例男性和6例女性），平均年龄33.4岁（范围22 - 65岁）。其中8例为股骨骨折，17例为胫骨骨折。所有骨折均由高能创伤导致且为开放性骨折。所有病例均表现为下肢长骨外固定后骨不连。所有患者均接受两阶段（延迟转换）接骨术治疗。对患者的骨愈合率和时间、相邻关节活动范围、改良的Karlstrom-Olerud功能结局评分以及创伤结局测量评分进行了评估。

结果

平均随访36.5个月（范围24 - 54个月）。22例（88%）平均在5.3个月时完全愈合。根据Karlstrom-Olerud评分，最终功能结局评分为优12例，良9例，可2例，差2例。关于创伤结局测量评分，3个月时平均TOM为26.1（25.3 - 27.3），12个月时为30.4（29.3 - 32.1），24个月时为33.4（32.3 - 40）。

结论

外固定后长骨骨不连的两阶段治疗技术是实现骨愈合的成功方法。它可能是一个并发症风险低且功能结局良好的有利选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/e939f43b4dbb/OS-13-426-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/7f500d2580ee/OS-13-426-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/843de6857b7f/OS-13-426-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/82fb70b74301/OS-13-426-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/128fdefacb52/OS-13-426-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/ba255bf46102/OS-13-426-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/e939f43b4dbb/OS-13-426-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/7f500d2580ee/OS-13-426-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/843de6857b7f/OS-13-426-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/82fb70b74301/OS-13-426-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/128fdefacb52/OS-13-426-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/ba255bf46102/OS-13-426-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/52d3/7957394/e939f43b4dbb/OS-13-426-g007.jpg

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Strategies Trauma Limb Reconstr. 2013 Apr;8(1):25-30. doi: 10.1007/s11751-013-0157-8. Epub 2013 Mar 9.
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What's new in limb lengthening and deformity correction.肢体延长与畸形矫正的新进展。
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Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail: a case-matched comparative study.使用或不使用辅助髓内钉的伊利扎洛夫方法进行胫骨延长的并发症及结果：一项病例匹配的对照研究。
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