Lammens J, Bauduin G, Driesen R, Moens P, Stuyck J, De Smet L, Fabry G
Department of Orthopaedic Surgery, Katholieke Universiteit Leuven, Belgium.
Clin Orthop Relat Res. 1998 Aug(353):223-30. doi: 10.1097/00003086-199808000-00026.
Ilizarov's method of monofocal compression was used in 30 humeri with a diaphyseal pseudarthrosis. Twenty-one patients had previous surgery but had loosening of the osteosynthesis material. Nine patients initially were treated with a hanging cast, resulting in interfragmentary distraction. Fourteen nonunions were hypertrophic, and 16 were atrophic, of which six were infected. A complete circular frame was used only in the first nine patients, whereas the remaining 21 patients were treated with the modified semicircular fixator. Union was obtained in all but two patients, with an average consolidation time of 4.5 months (range, 2.5-10 months). No patient required additional bone grafting. Apart from superficial pin tract infection seen in most of the patients, three had a minor temporary sensory neurologic problem. Four patients experienced a second fracture after removal of the fixator that required a second application of an Ilizarov frame. Although similar results with regard to union are reported after plate osteosynthesis, there was no radial nerve palsy or deep infection in this series, indicating that the treatment by the Ilizarov technique is associated with less complications. The authors' findings suggest that the Ilizarov method is a reliable treatment for humeral nonunions, even after multiple previous operations or in the event of infection.
采用伊里扎洛夫单焦点加压法治疗30例肱骨干假关节患者。21例患者曾接受过手术，但骨固定材料出现松动。9例患者最初采用悬吊石膏治疗，导致骨折端间出现牵引。14例骨不连为肥大性，16例为萎缩性，其中6例伴有感染。仅前9例患者使用了完整的环形外固定架，其余21例患者采用改良半环形固定器治疗。除2例患者外，其余患者均实现了骨愈合，平均愈合时间为4.5个月（范围为2.5 - 10个月）。无患者需要额外植骨。除大多数患者出现浅表针道感染外，3例患者出现轻微的暂时性感觉神经问题。4例患者在拆除固定器后发生二次骨折，需要再次应用伊里扎洛夫外固定架。尽管钢板内固定术后也有类似的骨愈合结果报道，但本系列中未出现桡神经麻痹或深部感染，表明伊里扎洛夫技术治疗相关并发症较少。作者的研究结果表明，即使在多次既往手术或发生感染的情况下，伊里扎洛夫方法仍是治疗肱骨骨不连的可靠方法。
