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
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 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.展开更多
BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone...BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies,including congenital deficiencies.Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments.AIM To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis,and present preliminary results of this technological solution.METHODS Seven adults with post-traumatic tibial defects(subgroup A)and nine children(subgroup B)with congenital pseudarthrosis of the tibia(CPT)were treated with the combination of IMT and IBT after the failure of previous treatments.The mean number of previous surgeries was 2.0±0.2 in subgroup A and 3.3±0.7 in subgroup B.Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal.Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane,its compression and docking for consolidation without grafting.The outcomes were retrospectively studied after a mean follow-up of 20.8±2.7 mo in subgroup A and 25.3±2.3 mo in subgroup B.RESULTS The“true defect”after resection was 13.3±1.7%in subgroup A and 31.0±3.0%in subgroup B relative to the contralateral limb.Upon completion of treatment,defects were filled by 75.4±10.6%and 34.6±4.2%,respectively.Total duration of external fixation was 397±9.2 and 270.1±16.3 d,including spacer retention time of 42.4±4.5 and 55.8±6.6 d,in subgroups A and B,respectively.Bone infection was not observed.Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups.Ischemic regeneration was observed in two cases of subgroup B.Complications were corrected during the course of treatment.Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B.One non-united CPT case was further treated with the Ilizarov compression method only and achieved union.After a follow-up period of two to three years,refractures occurred in four cases of united CPT.CONCLUSION The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention.Refractures may occur in severe CPT.展开更多
目的探讨抗生素骨水泥联合Ilizarov技术个性化治疗长骨感染性骨缺损的方法和临床疗效。方法自2011年6月至2017年1月,我院应用Ilizarov技术个性化治疗股骨、胫骨、肱骨骨折术后感染性骨缺损21例,男14例,女7例;年龄18～65岁,平均37岁。其...目的探讨抗生素骨水泥联合Ilizarov技术个性化治疗长骨感染性骨缺损的方法和临床疗效。方法自2011年6月至2017年1月,我院应用Ilizarov技术个性化治疗股骨、胫骨、肱骨骨折术后感染性骨缺损21例,男14例,女7例;年龄18～65岁,平均37岁。其中胫骨骨缺损12例,清创后骨缺损范围平均7.2cm;股骨骨缺损7例,清创后骨缺损范围平均8.5cm;肱骨骨缺损2例,清创后骨缺损范围平均6cm。手术分两期进行:一期彻底清创,植入含敏感抗生素骨水泥,采用单边或环形外固定架固定,预留截骨延长的外固定架长度,控制感染;二期感染消灭后,根据Ilizarov技术进行截骨延长。结果所有患者术后随访12～24个月,平均18.5个月。外固定架固定时间9～21个月,平均17.2个月。外固定架指数(external fixation index,EFI)平均为2.38个月/cm。采用伊里扎洛夫方法研究与应用学会(association for the study and application of the method of Ilizarov,ASAMI)评价标准评价,骨性结果:优13例,良6例,中2例,优良率为90.5%;功能结果:优11例,良7例,中3例,优良率为85.7%。结论抗生素骨水泥联合Ilizarov技术可有效控制感染,纠正患肢畸形,重建肢体的功能,是治疗长骨感染性骨缺损的有效方法。展开更多
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 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.
文摘BACKGROUND The Ilizarov bone transport(IBT)and the Masquelet induced membrane technique(IMT)have specific merits and shortcomings,but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies,including congenital deficiencies.Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments.AIM To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis,and present preliminary results of this technological solution.METHODS Seven adults with post-traumatic tibial defects(subgroup A)and nine children(subgroup B)with congenital pseudarthrosis of the tibia(CPT)were treated with the combination of IMT and IBT after the failure of previous treatments.The mean number of previous surgeries was 2.0±0.2 in subgroup A and 3.3±0.7 in subgroup B.Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal.Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane,its compression and docking for consolidation without grafting.The outcomes were retrospectively studied after a mean follow-up of 20.8±2.7 mo in subgroup A and 25.3±2.3 mo in subgroup B.RESULTS The“true defect”after resection was 13.3±1.7%in subgroup A and 31.0±3.0%in subgroup B relative to the contralateral limb.Upon completion of treatment,defects were filled by 75.4±10.6%and 34.6±4.2%,respectively.Total duration of external fixation was 397±9.2 and 270.1±16.3 d,including spacer retention time of 42.4±4.5 and 55.8±6.6 d,in subgroups A and B,respectively.Bone infection was not observed.Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups.Ischemic regeneration was observed in two cases of subgroup B.Complications were corrected during the course of treatment.Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B.One non-united CPT case was further treated with the Ilizarov compression method only and achieved union.After a follow-up period of two to three years,refractures occurred in four cases of united CPT.CONCLUSION The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention.Refractures may occur in severe CPT.
文摘目的探讨抗生素骨水泥联合Ilizarov技术个性化治疗长骨感染性骨缺损的方法和临床疗效。方法自2011年6月至2017年1月,我院应用Ilizarov技术个性化治疗股骨、胫骨、肱骨骨折术后感染性骨缺损21例,男14例,女7例;年龄18～65岁,平均37岁。其中胫骨骨缺损12例,清创后骨缺损范围平均7.2cm;股骨骨缺损7例,清创后骨缺损范围平均8.5cm;肱骨骨缺损2例,清创后骨缺损范围平均6cm。手术分两期进行:一期彻底清创,植入含敏感抗生素骨水泥,采用单边或环形外固定架固定,预留截骨延长的外固定架长度,控制感染;二期感染消灭后,根据Ilizarov技术进行截骨延长。结果所有患者术后随访12～24个月,平均18.5个月。外固定架固定时间9～21个月,平均17.2个月。外固定架指数(external fixation index,EFI)平均为2.38个月/cm。采用伊里扎洛夫方法研究与应用学会(association for the study and application of the method of Ilizarov,ASAMI)评价标准评价,骨性结果:优13例,良6例,中2例,优良率为90.5%;功能结果:优11例,良7例,中3例,优良率为85.7%。结论抗生素骨水泥联合Ilizarov技术可有效控制感染,纠正患肢畸形,重建肢体的功能,是治疗长骨感染性骨缺损的有效方法。
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。
