Department of Traumatology and Orthopedics, Ural State Medical University, 3, Repina Street, Ekaterinburg, 620109, Russia.
Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6, M. Ulianovoi Street, Kurgan, 640014, Russia.
Arch Orthop Trauma Surg. 2022 Sep;142(9):2185-2192. doi: 10.1007/s00402-021-03804-4. Epub 2021 Mar 2.
Post-traumatic nonunion of the femur remains a challenging problem even for experienced orthopedic surgeons. The main question is the choice of the optimal surgical tool.
Management of 20 patients with nonunion of the femoral diaphysis associated with anatomical shortening was retrospectively analyzed. Group A (n = 14) was treated with a hybrid technique that combined the Ilizarov external fixation and intramedullary nailing. The Ilizarov bone transport was used in group B (n = 6). Patients of both groups had aseptic post-traumatic nonunion. Mean shortening was 4.5 ± 0.4 cm in group A and 4.8 ± 1.0 cm in group B (p = 0.459959).
Union was achieved in 85.7% of group A and 100% of group B patients. External fixation was repeated in two cases of group A and achieved consolidation. Deep infection developed in one case of group A after 15 months post-frame with the nail in. It was resolved by nail removal, surgical debridement and external fixation. Limb shortening was fully eliminated in eleven cases of group A and four patients of group B. The average duration of distraction was 35.3 ± 1.7 days in group A and 47.8 ± 9.3 days in group B. The total duration of external fixation was 49.1 ± 3.5 and 177.2 ± 21.9 days with an external fixation index of 13.1 ± 1.2 and 52.4 ± 6.4 days/cm, respectively. Distraction regenerate consolidated in all the cases.
Hybrid technique provides bone union with compensation of limb shortening and reduces the treatment period as compared with the Ilizarov method used alone. However, deep infection may happen.
即使对于经验丰富的骨科医生来说，股骨创伤后不愈合仍然是一个具有挑战性的问题。主要问题是选择最佳的手术工具。
回顾性分析 20 例股骨骨干骨折伴解剖性短缩的非愈合患者。A 组（n=14）采用混合技术治疗，即伊利扎罗夫外固定架联合髓内钉。B 组（n=6）采用伊利扎罗夫骨搬运术。两组患者均为无菌性创伤后非愈合。A 组平均短缩 4.5±0.4cm，B 组平均短缩 4.8±1.0cm（p=0.459959）。
A 组 85.7%和 B 组 100%的患者达到骨愈合。A 组中有两例患者需要重复外固定架治疗以实现愈合。A 组中有一例患者在术后 15 个月发生带钉深部感染，经拔钉、手术清创和外固定架治疗后得到解决。A 组中有 11 例患者和 B 组中有 4 例患者肢体短缩完全消除。A 组平均牵伸时间为 35.3±1.7 天，B 组平均牵伸时间为 47.8±9.3 天。A 组外固定总时间为 49.1±3.5 天，外固定指数为 13.1±1.2 天/cm；B 组外固定总时间为 177.2±21.9 天，外固定指数为 52.4±6.4 天/cm。所有病例的牵张再生骨均得到愈合。
与单独使用伊利扎罗夫技术相比，混合技术可提供骨愈合，并补偿肢体短缩，同时缩短治疗时间。但可能发生深部感染。
