Salvage of infected non-union of the tibia with an Ilizarov ring fixator
Salvage of infected non-union of the tibia with an Ilizarov ring fixator
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DOI：
10.1177/230949901502300112
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发表时间：
2015-01-01
影响因子：
1.6
通讯作者：
Iqbal, Arshad
中科院分区：
文献类型：
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作者：
Khan, Muhammad Shahid;Rashid, Haroon;Iqbal, Arshad
目的。目的回顾24例接受Ilizarov环内固定治疗感染性胫骨不连的临床疗效。本文回顾了21名男性和3名女性的医疗记录，年龄13至74岁（平均38岁），他们接受了Ilizarov环固定治疗感染性胫骨不愈合。平均骨缺损3.3（范围，2-5）cm。从损伤到就诊的平均时间为11.9（范围，1-36）个月。既往平均手术次数2次（范围0-14次）。2例采用局部皮瓣，1例采用游离皮瓣。由于稳定性不足是导致骨不连的原因，9例患者接受了Ilizarov环固定，但未切除软组织和骨。采用Ilizarov标准方法研究与应用协会对患者进行评估。患者平均随访11个月（8-46个月）。8例患者功能预后良好，12例良好，2例一般，1例失败；6例患者骨愈合预后良好，14例良好，1例一般，2例较差。平均愈合时间8个月（范围3 ~ 31个月）。平均外固定指数为4.2（范围1.515.7）cm/月。并发症为针道感染（n= 5），再骨折（n= 2）， Ilizarov环撞击软组织（n= 2），伤口感染复发（n= 1），不愈合（n= 1），死亡（n= 1）。Ilizarov环固定是胫骨感染不愈合的可行选择。在取下固定架前对骨愈合进行充分评估以防止再次骨折至关重要。
Purpose. To review outcomes of 24 patients who underwent Ilizarov ring fixation for infected nonunion of the tibia.Methods. Medical records of 21 men and 3 women aged 13 to 74 (mean, 38) years who underwent Ilizarov ring fixation for infected non-union of the tibia were reviewed. The mean bone defect was 3.3 (range, 2-5) cm. The mean time from injury to presentation was 11.9 (range, 1-36) months. The mean number of previous surgeries was 2 (range, 0-14). A local flap was used in 2 patients and a free flap was used in one patient. Nine of the patients underwent Ilizarov ring fixation without soft tissue and bony resection, as inadequate stability was the reason for non-union. Patients were assessed using the Association for the Study and Application of the Method of Ilizarov criteria.Results. Patients were followed up for a mean of 11 (range, 8-46) months. Functional outcome was excellent in 8 patients, good in 12, fair in 2, and failure in one, whereas bone union outcome was excellent in 6 patients, good in 14, fair in one, and poor in 2. The mean time to union was 8 (range, 3-31) months. The mean external fixation index was 4.2 (range, 1.515.7) cm/ month. Complications encountered were pin tract infection (n= 5), re-fracture (n= 2), soft tissue impingement by Ilizarov rings (n= 2), recurrence of wound infection (n= 1), mal-union (n= 1), and mortality (n= 1).Conclusion. Ilizarov ring fixation is a viable option for infected non-union of the tibia. Adequate assessment of bone union is crucial before removal of fixator to prevent re-fracture.