Marsh D R, Shah S, Elliott J, Kurdy N
Hope Hospital, Salford, England.
J Bone Joint Surg Br. 1997 Mar;79(2):273-9. doi: 10.1302/0301-620x.79b2.6636.
We have reviewed a series of 56 consecutive patients treated by the Ilizarov circular fixator for various combinations of nonunion, malunion and infection of fractures. We used segmental excision, distraction osteogenesis and gradual correction of the deformity as appropriate. Treatment was effective in eliminating 40 out of 46 nonunions and all 22 infections. There were two cases of refracture some months after removal of the frame, both of which healed securely in a second frame. Correction of malunion was good in the coronal plane but there was a tendency to anterior angulation, often occurring in the regenerate bone rather than at the original fracture site, after removal of the frame. This was associated with very slow maturation of regenerate bone in some patients, occurring largely, but not exclusively, in those who smoked heavily. Patients expressed high levels of satisfaction with the outcome, despite relatively modest improvements in pain and function, presumably because their longstanding and intractable nonunion had been treated. None the less, the degree of satisfaction correlated strongly with the degree of improvement in pain and function. We emphasise the importance of a multidisciplinary team in the assessment and support of patients undergoing long and demanding treatment. The Ilizarov method is valuable, but research is needed to overcome the problems of delayed maturation of the regenerate and slow or insecure healing of the docking site.
我们回顾了连续56例采用伊里扎洛夫环形固定器治疗的患者，这些患者存在骨折不愈合、畸形愈合及感染的各种不同组合情况。我们酌情采用节段性切除、牵张成骨及逐步矫正畸形的方法。治疗成功消除了46例骨折不愈合中的40例以及所有22例感染。拆除固定架数月后有2例再次骨折，二者均在重新使用固定架后牢固愈合。畸形愈合在冠状面矫正良好，但拆除固定架后有向前成角的趋势，这种情况常发生于新生骨而非原骨折部位。这与部分患者新生骨成熟非常缓慢有关，在很大程度上，但并非全部，发生于重度吸烟者。尽管疼痛和功能改善相对有限，但患者对治疗结果表示高度满意，推测原因是他们长期存在的难治性骨折不愈合得到了治疗。尽管如此，满意度程度与疼痛和功能改善程度密切相关。我们强调多学科团队在评估和支持接受长期且要求苛刻治疗的患者方面的重要性。伊里扎洛夫方法很有价值，但需要开展研究以克服新生骨成熟延迟以及对接部位愈合缓慢或不牢固的问题。
