Role of the Ilizarov non-free bone plasty in the management of long bone defects and nonunion: Problems solved and unsolved
Role of the Ilizarov non-free bone plasty in the management of long bone defects and nonunion: Problems solved and unsolved
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DOI：
10.5312/wjo.v11.i6.304
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发表时间：
2020-06-18
影响因子：
1.9
通讯作者：
Malkova, Tatiana A.
中科院分区：
文献类型：
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作者：
Borzunov, Dmitry Y.;Kolchin, Sergei N.;Malkova, Tatiana A.
背景：Ilizarov非游离骨成形术是一种利用Ilizarov外固定器进行牵张成骨的方法，起源于俄罗斯，并在世界范围内传播。它与带血管的游离移植和诱导膜技术一起沿着用于长管状骨缺损和骨不连的治疗。然而，这些方法的缺点和问题仍然存在，限制了它们的全面使用。目的探讨Ilizarov非游离骨成形术在长骨骨缺损及骨不连治疗中的作用、存在的问题及解决方法，以期获得更好的治疗效果。方法检索了3个数据库（PubMed、Scopus和Web of Science），以查找5年（2015-2019年）内关于牵引成骨、游离血管化移植和诱导膜技术用于长骨缺损和骨不连治疗的文献来源。仅当包含治疗结果、并发症并描述了大量患者样本（先天性、肿瘤切除后病例或罕见疾病不少于10例，其余病例超过20例）时，才选择英文全文临床文章进行分析。病例报告被排除。结果：共检索到50篇关于牵张成骨的全文和综述。我们分析了35项临床研究，这些研究包含了用这种方法治疗的大量患者及其结局问题。研究发现，牵张成骨技术在许多临床情况下，特别是在复杂的问题中，为下肢节段性骨缺损和骨不连提供了治疗。Ilizarov技术同时治疗三大问题（骨丢失，软组织丢失和感染）。胫骨缺损的治疗主要使用Ilizarov环形固定器。单侧固定器在股骨中是优选的。对于胫骨感染间隙超过6 cm的患者，建议使用环形固定器。作者报告的治疗成功率较高，范围为77%-100%，取决于病理学和使用的Ilizarov技术类型。混合固定和自体移植是避免后支架再生骨折或畸形和对接部位不愈合的最适用的解决方案。结论Ilizarov非游离骨成形术在节段性骨缺损的治疗中虽有不足之处，但仍具有重要意义。
BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use. AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes. METHODS Three databases (PubMed, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period (2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results, complications and described large patient samples (not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded. RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen. Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously (bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion. CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.