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...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(Pub Med, 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 展开更多
The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixa...The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA.Its main merits are viable new bone formation through distraction osteogenesis,high union rates and functional use of the limb throughout the course of treatment.The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery.Since then,the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails.They gave rise to a relatively new orthopedic subspecialty termed“limb lengthening and reconstruction surgery”.Based on a comprehensive literature search,we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community.The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating.The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents.It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.展开更多
[目的]比较骨搬运与包裹植骨治疗单纯胫骨大段骨缺损的效果。[方法]回顾性分析2009年1月～2016年12月80例皮肤条件相对良好的胫骨骨缺损>5 cm患者。按修复骨缺损方法不同分为骨搬运组(49例)和包裹植骨组(31例)。两组患者在年龄、性...[目的]比较骨搬运与包裹植骨治疗单纯胫骨大段骨缺损的效果。[方法]回顾性分析2009年1月～2016年12月80例皮肤条件相对良好的胫骨骨缺损>5 cm患者。按修复骨缺损方法不同分为骨搬运组(49例)和包裹植骨组(31例)。两组患者在年龄、性别、缺损原因、缺损距离骨修复时间和合并伤方面比较,差异均无统计学意义(P>0.05)。比较两组下地时间、负重时间、骨不连、骨愈合时间、并发症、骨缺损修复手术费用和末次随访患肢邻近关节功能恢复(Johner-Wruhs评价方法)等情况。[结果]骨搬运组与包裹植骨组在卧床时间[(23.36±6.72) d vs(27.26±12.21) d,P>0.05]、负重行走时间[(95.98±15.67) d vs (102.55±17.54) d,P>0.05]的差异无统计学意义。但是,骨搬运组的骨不连发生率显著高于包裹植骨组,差异有统计学意义[(18/49) vs (1/31),P<0.05],对骨不连者行二次手术清创植骨内固定,二次术后均达到骨性愈合。骨搬运组的骨愈合时间显著长于包裹植骨组,差异有统计学意义[(11.10±3.44)个月vs (7.77±1.67)个月,P<0.05]。此外,骨搬运组的治疗费用显著高于包裹植骨组,差异有统计学意义[(7.66±2.05)万元vs (4.46±1.20)万元,P<0.05]。末次随访时,两组患者Johner-Wruhs评定的临床效果差异无统计学意义(P>0.05)。[结论]对于单纯胫骨大段骨缺损,骨搬运和包裹植骨均是有效方法,但包裹植骨在骨愈合效果、治疗费用和并发症方面优于骨搬运。展开更多
文摘目的探讨应用IIizarov外固定架骨搬运技术治疗胫骨骨折术后感染、骨缺损临床疗效。方法对60例胫骨骨折术后感染、骨缺损患者依据Ilizarov技术标准进行治疗。术后定期摄X线片复查,评估牵张成骨情况。结果 60例均获得随访,时间18~30个月。骨搬运完成时间2~7个月,骨搬运长度6~18 cm。患者未出现血管神经损伤等并发症。6例出现钉道反应,1例切口皮缘水肿,均经治疗后愈合;17例搬运后期出现对线不良,经调整骨搬运方向、少量植骨,均获对位对线骨性愈合。骨搬运完成后9个月,按Paley et al骨折愈合评分标准评价疗效:优45例,良6例,可8例,差1例。骨缺损断端骨愈合及牵张成骨区成骨愈合满意,软组织创面愈合满意,所有患肢长度恢复良好,与健侧对比无明显差异。结论采用Ilizarov外固定架骨搬运技术进行感染扩创、炎性病变切除、骨段搬运修复骨缺损,对胫骨术后感染的控制、肢体功能的重建具有确切的临床疗效。
文摘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(Pub Med, 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
文摘The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA.Its main merits are viable new bone formation through distraction osteogenesis,high union rates and functional use of the limb throughout the course of treatment.The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery.Since then,the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails.They gave rise to a relatively new orthopedic subspecialty termed“limb lengthening and reconstruction surgery”.Based on a comprehensive literature search,we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community.The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating.The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents.It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.
文摘[目的]比较骨搬运与包裹植骨治疗单纯胫骨大段骨缺损的效果。[方法]回顾性分析2009年1月～2016年12月80例皮肤条件相对良好的胫骨骨缺损>5 cm患者。按修复骨缺损方法不同分为骨搬运组(49例)和包裹植骨组(31例)。两组患者在年龄、性别、缺损原因、缺损距离骨修复时间和合并伤方面比较,差异均无统计学意义(P>0.05)。比较两组下地时间、负重时间、骨不连、骨愈合时间、并发症、骨缺损修复手术费用和末次随访患肢邻近关节功能恢复(Johner-Wruhs评价方法)等情况。[结果]骨搬运组与包裹植骨组在卧床时间[(23.36±6.72) d vs(27.26±12.21) d,P>0.05]、负重行走时间[(95.98±15.67) d vs (102.55±17.54) d,P>0.05]的差异无统计学意义。但是,骨搬运组的骨不连发生率显著高于包裹植骨组,差异有统计学意义[(18/49) vs (1/31),P<0.05],对骨不连者行二次手术清创植骨内固定,二次术后均达到骨性愈合。骨搬运组的骨愈合时间显著长于包裹植骨组,差异有统计学意义[(11.10±3.44)个月vs (7.77±1.67)个月,P<0.05]。此外,骨搬运组的治疗费用显著高于包裹植骨组,差异有统计学意义[(7.66±2.05)万元vs (4.46±1.20)万元,P<0.05]。末次随访时,两组患者Johner-Wruhs评定的临床效果差异无统计学意义(P>0.05)。[结论]对于单纯胫骨大段骨缺损,骨搬运和包裹植骨均是有效方法,但包裹植骨在骨愈合效果、治疗费用和并发症方面优于骨搬运。
