治疗因战斗相关高能弹道伤导致的 Gustilo-Anderson 3A-B 型胫骨骨折的外环形固定器治疗的长期结果：军事医学院的经验。

Long-term results of treatment of Gustilo-Anderson type 3A-B tibia fractures due to combat-related high-energy ballistic injuries treated with external circular fixator: Experience of the Military Medical Academy.

机构信息

Gülhane Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, 06010 Etlik, Ankara, Türkiye.

出版信息

Jt Dis Relat Surg. 2024 Aug 14;35(3):637-644. doi: 10.52312/jdrs.2024.1797.

DOI:10.52312/jdrs.2024.1797

PMID:39189574

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11411876/

Abstract

OBJECTIVES

The aim of this study was to evaluate the longterm outcomes of open tibia fractures treated using the Ilizarov external circular fixation (ECF) technique in the Military Medical Academy.

PATIENTS AND METHODS

Between January 1992 and December 2011, a total of 134 male military personnel (median age: 22.5 years; range, 18 to 36 years) with Gustilo-Anderson type 3 open tibia fractures treated with ECF were retrospectively analyzed. All patients underwent multiple surgeries and eventually Ilizarov fixation surgery. The radiological and functional outcomes were evaluated using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, and complications were noted.

RESULTS

The median follow-up was 17.7 (range, 10 to 29) years. The median time to union was 4.7 (range, 3 to 8) months. All frames were removed from the limb, when union was observed. No re-fracture, limb length discrepancy more than 2.5 cm, or below-knee amputation after Ilizarov treatment was seen in any patient. Chronic osteomyelitis was observed at in 40% (n=54) of the patients at a median time ranging from 17 to 148 months. The overall ASAMI bone scores were excellent in 40 (30%), good in 20 (15%), fair in 20 (15%), and poor in 54 (40%) patients with osteomyelitis. The ASAMI functional scores were excellent in 40 (30%), good in 40 (30%), and fair in 54 patients (40%). No poor score was observed. Minor pin site infections were observed in 63 patients (47%).

CONCLUSION

Our long-term study results showed that all patients returned to their social life and were mobilized without support after treatment with the use of Ilizarov ECF method of open tibia fractures caused by high-energy ballistic injuries. However, complications such as pin tract infections and osteomyelitis after several years must be kept in mind in the treatment of comminuted bone fractures caused by firearms and ballistic missiles injuries.

摘要

目的

本研究旨在评估军事医学科学院采用伊利扎洛夫外固定环（ECF）技术治疗开放性胫骨骨折的长期疗效。

患者和方法

1992 年 1 月至 2011 年 12 月，回顾性分析了 134 例男性军人（中位年龄：22.5 岁；范围：18 至 36 岁）采用 ECF 治疗的 Gustilo-Anderson 型 3 型开放性胫骨骨折。所有患者均接受多次手术，最终接受伊利扎洛夫固定术。采用 Association for the Study and Application of Methods of Ilizarov（ASAMI）标准评估影像学和功能结果，并记录并发症。

结果

中位随访时间为 17.7（范围：10 至 29）年。骨折愈合时间的中位数为 4.7（范围：3 至 8）个月。当观察到愈合时，所有的外固定架均从肢体上移除。在伊利扎洛夫治疗后，没有患者出现再骨折、肢体长度差异超过 2.5cm 或膝下截肢。40%（n=54）的患者在 17 至 148 个月的中位时间出现慢性骨髓炎。患有骨髓炎的患者中，ASAMI 骨评分总分为优秀的有 40（30%），良好的有 20（15%），尚可的有 20（15%），差的有 54（40%）。ASAMI 功能评分总分为优秀的有 40（30%），良好的有 40（30%），尚可的有 54 例（40%）。没有差的评分。63 例（47%）患者出现轻微的针道感染。