Miraj Faisal, Nugroho Ahmad, Dalitan Ivan Mucharry, Setyarani Melitta
Pediatrics Orthopaedics and Limb Reconstruction Division, Department of Orthopaedics and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia.
Resident of Orthopaedics and Traumatology Department, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia/ Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Ann Med Surg (Lond). 2021 Jul 31;68:102645. doi: 10.1016/j.amsu.2021.102645. eCollection 2021 Aug.
Patients with open fracture Gustillo-Anderson grade 3 had undergone several surgical procedures, but still ended up with expose long dead bone or infected. Illizarov method was used to address long bone and soft tissue defect after re-debridement with radical resection of long dead bone or infected segment.
We included 14 patients (mean age: 30.86 ± 11.49) with non-union tibial fracture with long dead and infected bone segment who had undergone several debridement, bone grafting or spacer and soft tissue closure procedure due to open fracture of tibia grade 3. The subjects underwent re-debridement with radical resection of dead or infected bone segment followed by Illizarov method to perform bone transport procedure for bone defect filling and simultaneously restore severe soft tissue loss and bone lengthening procedure.
All subjects had achieved satisfactory results with mean docking period of bone transport 3.78 ± 0.54 months, union time at the docking side 7 (5.5-9) months. Soft tissue was covered and no recurrence of infection. Three subjects had Leg Length Discrepancy (LLD) of 1 cm, whereas the remaining had zero discrepancy. No significant pain was observed at final follow-up and 4 patients had ankle joint stiffness.
The Illizarov method can effectively address long bone and soft tissue defects by distraction osteogenesis through bone transport procedure that filling the defect gradually without bone graft and simultaneously enhancing soft tissue closure without tertiary soft tissue procedure subsequently followed with bone lengthening procedure to correct the limb length discrepancy.
开放性骨折Gustillo-Anderson 3级患者接受了多次外科手术，但最终仍出现长死骨暴露或感染。在对长死骨或感染节段进行彻底切除的再次清创术后，采用伊利扎洛夫方法处理长骨和软组织缺损。
我们纳入了14例（平均年龄：30.86±11.49岁）胫骨骨折不愈合且伴有长死骨和感染骨节段的患者，这些患者因胫骨3级开放性骨折接受了多次清创、植骨或置入间隔物以及软组织闭合手术。受试者接受再次清创，彻底切除死骨或感染骨节段，随后采用伊利扎洛夫方法进行骨搬运手术以填充骨缺损，同时修复严重的软组织缺损并进行骨延长手术。
所有受试者均取得了满意的效果，骨搬运的平均对接期为3.78±0.54个月，对接侧的愈合时间为7（5.5 - 9）个月。软组织得到覆盖，感染无复发。3例受试者存在1厘米的下肢长度差异（LLD），其余受试者差异为零。末次随访时未观察到明显疼痛，4例患者出现踝关节僵硬。
伊利扎洛夫方法可通过骨搬运过程中的牵张成骨有效地处理长骨和软组织缺损，该过程无需植骨即可逐渐填充缺损，并在不进行三期软组织手术的情况下增强软组织闭合，随后进行骨延长手术以纠正肢体长度差异。
