中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2012年
3期
217-221
,共5页
康庆林%陆联松%程栋%喻鑫罡%郭燕杰%柴益民%张长青%曾炳芳
康慶林%陸聯鬆%程棟%喻鑫罡%郭燕傑%柴益民%張長青%曾炳芳
강경림%륙련송%정동%유흠강%곽연걸%시익민%장장청%증병방
伊利扎罗夫技术%外固定器%骨生成,牵张%骨折,不愈合
伊利扎囉伕技術%外固定器%骨生成,牽張%骨摺,不愈閤
이리찰라부기술%외고정기%골생성,견장%골절,불유합
Ilizarov technique%External fixators%Osteogenesis,distraction%Fractures,ununited
目的 探讨采用Ilizarov外固定器治疗肥大性骨不连的疗效.方法 回顾性分析2008年6月至2010年12月,采用Ilizarov环型外固定器直接牵张治疗肥大性骨不连患者的病例,男10例,女2例;年龄22~62岁,平均46.5岁;肱骨中段1例,股骨髁上2例,胫骨中段3例,胫骨中下1/3交界处6例;患肢畸形成角10°~35°,平均25°,其中2例为双平面畸形,10例为单平面畸形;肢体短缩2~6 cm,平均3.5 cm.所有患者术前均拍摄双下肢全长X线片.对骨断端尽量不切开,局部不植骨,直接安装预构的Ilizarov外固定器.对局部留存内固定物者,采用微创的方法取出,尽量保护骨断端血供.术后第7天开始进行矫形延长,断端处每天延长0.25 mm.在恢复肢体长度的同时,矫正成角畸形,对双平面畸形,先矫正冠状面畸形,再矫正矢状面畸形.结果 12例骨不连患者均通过断端直接牵张成骨而获得骨性愈合,骨断端无需植骨.骨性愈合时间6~12个月,平均8个月.成角畸形和肢体不等长全部获得矫正.畸形矫正时间15~35 d,平均24 d.畸形矫正10°~30°,平均23°.患肢延长2.0~5.5 cm,平均3.0 cm.随访6~18个月,平均14个月,所有患者获得的矫形均未丢失.结论 肥大性骨不连断端间纤维骨痂有活跃的成骨潜能,采用Ilizarov外固定器治疗肥大性骨不连可取得满意的疗效.
目的 探討採用Ilizarov外固定器治療肥大性骨不連的療效.方法 迴顧性分析2008年6月至2010年12月,採用Ilizarov環型外固定器直接牽張治療肥大性骨不連患者的病例,男10例,女2例;年齡22~62歲,平均46.5歲;肱骨中段1例,股骨髁上2例,脛骨中段3例,脛骨中下1/3交界處6例;患肢畸形成角10°~35°,平均25°,其中2例為雙平麵畸形,10例為單平麵畸形;肢體短縮2~6 cm,平均3.5 cm.所有患者術前均拍攝雙下肢全長X線片.對骨斷耑儘量不切開,跼部不植骨,直接安裝預構的Ilizarov外固定器.對跼部留存內固定物者,採用微創的方法取齣,儘量保護骨斷耑血供.術後第7天開始進行矯形延長,斷耑處每天延長0.25 mm.在恢複肢體長度的同時,矯正成角畸形,對雙平麵畸形,先矯正冠狀麵畸形,再矯正矢狀麵畸形.結果 12例骨不連患者均通過斷耑直接牽張成骨而穫得骨性愈閤,骨斷耑無需植骨.骨性愈閤時間6~12箇月,平均8箇月.成角畸形和肢體不等長全部穫得矯正.畸形矯正時間15~35 d,平均24 d.畸形矯正10°~30°,平均23°.患肢延長2.0~5.5 cm,平均3.0 cm.隨訪6~18箇月,平均14箇月,所有患者穫得的矯形均未丟失.結論 肥大性骨不連斷耑間纖維骨痂有活躍的成骨潛能,採用Ilizarov外固定器治療肥大性骨不連可取得滿意的療效.
목적 탐토채용Ilizarov외고정기치료비대성골불련적료효.방법 회고성분석2008년6월지2010년12월,채용Ilizarov배형외고정기직접견장치료비대성골불련환자적병례,남10례,녀2례;년령22~62세,평균46.5세;굉골중단1례,고골과상2례,경골중단3례,경골중하1/3교계처6례;환지기형성각10°~35°,평균25°,기중2례위쌍평면기형,10례위단평면기형;지체단축2~6 cm,평균3.5 cm.소유환자술전균박섭쌍하지전장X선편.대골단단진량불절개,국부불식골,직접안장예구적Ilizarov외고정기.대국부류존내고정물자,채용미창적방법취출,진량보호골단단혈공.술후제7천개시진행교형연장,단단처매천연장0.25 mm.재회복지체장도적동시,교정성각기형,대쌍평면기형,선교정관상면기형,재교정시상면기형.결과 12례골불련환자균통과단단직접견장성골이획득골성유합,골단단무수식골.골성유합시간6~12개월,평균8개월.성각기형화지체불등장전부획득교정.기형교정시간15~35 d,평균24 d.기형교정10°~30°,평균23°.환지연장2.0~5.5 cm,평균3.0 cm.수방6~18개월,평균14개월,소유환자획득적교형균미주실.결론 비대성골불련단단간섬유골가유활약적성골잠능,채용Ilizarov외고정기치료비대성골불련가취득만의적료효.
Objective To evalute the effect of Ilizarov technique in the treatment of hypertrophic nonunion.Methods Form June 2008 to December 2010,12 patients with hypertrophic nonunion were treated with Ilizarov technique,including 10 males and 2 females with an average age of 46.5 years.The pathology sites of nonunion were kept as closed as possible without any bone graft during operation.As to patients who had ever been treated with plate or intramedullary nail,the hardware should be removed by minimal invasive approach.These procedures aimed to keep the vascularity of nonunion site intact.Ilizarov apparatus were preoperatively constructed.Distal segment and proximal segment of nonunion were mounted respectively with two external circle using the smooth wires and half pins.The two-circle stabilizing one segment was nominated with transosseous modules.Distal module and proximal one was connected with a pair of axial hinges.The pathology sites were gradually distracted from the seventh day postoperatively,0.25 mm/d.Accompanying with deformity correction,limb length discrepancy (LLD) also were restored simultaneously.Then,all the screws and nuts in the apparatus should be tightened,which was favourable to the callus consolidation.Results All 12 cases of nonunion healed without any bone graft.The fixator wearing time lasted 6-12 months,with an average of 8 months.Correction of deformity and LLD were achieved.The average lengthening was 3.0 cm (range,2.0-5.5 cm),the average correction angle was 23° (range,10°-30°).After 6-18 months follow-up,all the patients restored satisfactory function.Conclusion Hypertrophic nonunion can be treated successfully with Ilizarov technique.The key of successful callus distraction is strictly identifying the indications.