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首页> 外文期刊>Injury >Acute treatment of segmental tibial fractures with the Ilizarov method.
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Acute treatment of segmental tibial fractures with the Ilizarov method.

机译：Ilizarov方法对胫骨节段骨折进行急性治疗。

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OBJECTIVES: We evaluated the results of acute application of the Ilizarov external fixator for segmental tibial fractures and also examined the experience with these special type fractures. METHODS: Twenty-four patients (19 males, 5 females) with a mean age of 37.8 years (range 22-66) with segmental tibial fractures were treated with the use of an Ilizarov type circular fixator. According to the categorisation of Melis et al., the fractures were types I, II, III and IV in seven, nine, five and three patients, respectively. Seven fractures were closed and 17 were open (9 grade IIIa, 5 grade IIIb, 2 grade II, 1 grade I according to the Gustilo classification). The mean time from the injury to surgery was 14 h (range 4-36). Eight patients with partial-thickness soft-tissue defects with no bone exposure were managed by split thickness skin grafting. Flap procedures were performed in four patients. All patients had good lower leg viability with a MESS score 6 and below. No patients had bone defects of 3 cm or more at the fracture level. Functional and bone results were made using the criteria proposed by ASAMI. The mean follow-up 28 months (range 12-70). RESULTS: We obtained excellent results in 20 and good results in 4 patients in terms of bone assessment. Functional results were excellent in 19 and good in 5 patients. All radiological evaluations showed normal alignment except in two patients. Both united with a residual procurvatum deformity. No rotational deformity was seen. Bone grafting was performed in one patient with a distal fracture. Complete union was achieved in all patients. None of the patients required amputation. There were no refractures after frame removal. Pin-tract infection occurred in 13 of the 24 patients. There were no incidents of chronic osteomyelitis secondary to pin-tract infection. The mean time for proximal fracture union was 36.4 weeks (range 10-78) and 39.8 weeks (range 12-80) for the distal fractures (p>0.05). Callus and consolidation occurred earlier posterolaterally. There were no implant failures. CONCLUSION: Ilizarov external fixator is a successful method in the acute management of segmental tibial fractures. This method is particularly effective in the treatment of distal segmental fractures of the tibia when the distal segment is short. This method allows for control of complications by decreasing the need for new operations even in the presence of infection.
机译：目的：我们评估了Ilizarov外固定器急性治疗胫骨节段性骨折的效果，并评估了这些特殊类型骨折的经验。方法：使用Ilizarov型圆形固定器治疗24例平均年龄37.8岁（范围22-66）的胫骨节段性骨折的患者（男19例，女5例）。根据Melis等人的分类，分别有7、9、5和3例患者的骨折类型为I，II，III和IV型。根据Gustilo分类，闭合了7处骨折，其中17处是开放的（9a级IIIa，5b级IIIb，2级II级，1级I级）。从受伤到手术的平均时间为14小时（范围4-36）。 8例具有部分厚度的软组织缺损且无骨暴露的患者通过厚薄的皮肤移植进行治疗。皮瓣程序进行了四名患者。所有患者的小腿生存力均良好，MESS评分为6及以下。没有患者在骨折水平上有3 cm或以上的骨缺损。使用ASAMI提出的标准进行功能和骨骼测试。平均随访28个月（范围12-70）。结果：就骨评估而言，我们在20例患者中获得了出色的结果，在4例患者中获得了好的结果。功能性结果优良19例，良好5例。所有放射学评估均显示正常对齐，只有两名患者除外。两者都合并有残留的前弓畸形。没有看到旋转变形。对一名远端骨折的患者进行了植骨。所有患者均完全愈合。没有患者需要截肢。取下镜框后无骨折。 24例患者中有13例发生针道感染。没有发生由针道感染引起的慢性骨髓炎。远端骨折的平均时间为36.4周（范围10-78），远端骨折的平均时间为39.8周（范围12-80）（p> 0.05）。 us骨和巩固发生在后外侧。没有植入失败。结论：伊利扎洛夫外固定架是治疗胫骨节段性骨折的一种成功方法。当远端节段短时，该方法在治疗胫骨的远端节段骨折方面特别有效。该方法即使在存在感染的情况下也可以通过减少对新手术的需求来控制并发症。

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