Bifocal compression-distraction in the acute treatment of grade III open tibia fractures with bone and soft-tissue loss - A report of 24 cases
Bifocal compression-distraction in the acute treatment of grade III open tibia fractures with bone and soft-tissue loss - A report of 24 cases
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DOI：
10.1097/00005131-200403000-00005
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发表时间：
2004-03-01
影响因子：
2.3
通讯作者：
Cinar, M
中科院分区：
文献类型：
--
作者：
Sen, C;Kocaoglu, M;Cinar, M
目的：目的：评价双焦点加压-撑开法治疗急性胫骨开放性骨折伴骨和软组织缺损的效果。设计：选择患者进行双焦点加压-撑开术（缩短和延长）的患者，其具有开放性胫骨骨折，伴有骨和软组织损失，并且6分和6分以下的损伤严重性评分指示良好的腿部活力。使用Ilizarov型环形外固定器进行双焦点加压-牵引成骨术，治疗24例伴有骨和软组织缺损的IIIA级和IIIB级胫骨开放性骨折患者。患者的平均年龄为30.6岁（范围18-53岁）。平均骨缺损5 cm（范围3-8.5）。平均软组织缺损为2.5 x 3.5（1 x 2-10 x 5）cm。干预措施：对于骨缺损达3 cm的患者，在骨折部位进行急性缩短，以实现骨端对合。对于骨缺损超过3 cm的患者，以2 mm/d的速率进行逐渐缩短。腿长度的差异是克服延长在同一时间通过皮质切开术在近端或远端水平取决于骨折location. Results的水平，直到有均衡的腿lengths.Results：平均随访期为30个月（范围18-60）。平均骨愈合时间为7.5个月（范围4-11）。外固定时间3-10个月，平均7.1个月，外固定指数1.4个月/cm。使用Paley骨和功能评估评分对结果进行评价。骨评估结果：优21例，良3例。19例患者的功能评估评分为优，4例为良，1例为一般。10.7%的钉扎部位存在钉扎部位感染。24例患者发生52例并发症，每例患者的并发症发生率为2.08。在并发症中，48.1%为问题（轻微并发症），38.5%为障碍（需要手术解决的严重并发症），13.4%为后遗症（真正并发症）。轻微并发症包括软组织炎症和感染、平移/成角、牵引期间成熟延迟、短暂性膝关节挛缩和活动度丧失。所有1级和2级软组织炎症和感染均经非手术治疗愈合。主要并发症包括针道感染和再感染、马蹄足畸形、框架失效和过早巩固，所有这些都需要额外的手术来纠正问题。后遗症包括下肢不等长，膝关节/踝关节活动范围的损失，膝关节屈曲挛缩，对线不良，和慢性骨髓炎。结论：双焦点压缩-牵引成骨是一种安全，可靠的，并在很大程度上成功的方法，为急性开放性胫骨骨折骨和软组织损失的治疗。进一步的非手术或手术治疗可以纠正大多数并发症。
Objective: To evaluate the results of bifocal compression-distraction method for the acute treatment of open tibia fractures with bone and soft-tissue loss.Design: Patients were selected for bifocal compression-distraction (shortening and lengthening) who had open tibia fractures with bone and soft-tissue loss and a Mangled Extremity Severe Score of 6 and below indicating good leg viability.Patients: Bifocal compression-distraction osteogenesis using the Ilizarov type circular external fixator was applied to 24 patients with 14 grade IIIA and 10 grade IIIB open tibia fractures with bone and soft-tissue loss. Mean age of the patients was 30.6 years (range 18-53). The mean bone defect was 5 cm (range 3-8.5). The mean soft tissue defect was 2.5 x 3.5 (1 x 2-10 x 5) cm.Interventions: Acute shortening at the fracture site was done for patients with bone defects up to 3 cm to achieve apposition of bone ends. Gradual shortening at a rate of 2 mm/d was done for patients who had bone defects more than 3 cm. Leg length discrepancy was overcome by lengthening at the same time through a corticotomy at a proximal or distal level depending on fracture localization, until there was equalization of leg lengths.Results: Mean follow-up period was 30 months (range 18-60). Mean bone healing time was 7.5 months (range 4-11). The mean time in external fixation was 7.1 months (range 3-10), and the average external fixator index was 1.4 months/cm. Results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 21 and good in 3 patients. Functional assessment scores were excellent in 19, good in 4, and fair in 1 patient. Pin site infections were present in 10.7% of the pin sites. There were 52 complications in 24 patients, for a complication rate per patient of 2.08. Of the complications, 48.1% were problems (minor complications), 38.5% obstacles (major complications requiring a surgical solution), and 13.4% sequelae (true complications). Minor complications included soft tissue inflammation and infection, translation/angulation, and delayed maturation during distraction and transient knee contracture and loss of motion. All grade 1 and 2 soft tissue inflammations and infections healed with nonoperative therapy. Major complications included pin tract infection and reinfection, equinus deformity, frame failure, and premature consolidation, all of which required additional surgery to correct the problem. Sequelae included leg length discrepancy, loss of knee/ankle range of motion, knee flexion contracture, malalignment, and chronic osteomyelitis.Conclusion: Bifocal compression-distraction osteogenesis is a safe, reliable, and largely successful method for the acute treatment of open tibia fractures with bone and soft-tissue loss. Further nonoperative or operative treatment can correct most complications.