Objective: To explore the effectiveness and method of Ilizarov technology for the treatment of infected forearm nonunion.
Methods: Between January 2004 and March 2014, 19 patients with infected forearm nonunion were treated, including 12 males and 7 females with a mean age of 37.4 years (range, 18-62 years). The injury causes included traffic accident in 11 patients, falling from height in 4 patients, and machine twist injury in 4 patients. The patients had received surgical treatment for 1-5 times (mean, 2.7 times). Bone defects located at the radius in 10 cases, at the ulna in 7 cases, and at the radius and ulna in 2 cases. The mean time of chronic infection was 8.3 months (range, 4-16 months). The mean length of the bone defects after debridement was 3.54 cm (range, 2.2-7.5 cm). Under the guidance of C-arm fluoroscope, the Orthofix unilateral external fixator was used to fix. Distraction was performed at 7-10 days after operation, and X-ray film was taken regularly to detect the osteogenesis.
Results: The mean external fixation time was 6.5 months (range, 3-12 months), and the mean external fixation index was 1.72 months/cm (range, 1.14-2.15 months/cm). All patients were followed up for 35.4 months on average (range, 24-55 months). The bone union time was 3-11 months (mean, 6 months); and no recurrence of infection was observed. At last follow-up, the mean wrist range of motion (ROM) were 52.78° (range, 42-55°) in flexion and 46.53° (range, 40-60°) in extension; the mean elbow ROM were 139.23° (range, 130-150°) in flexion and 3.57° (range, 0-20°) in extension; and the mean forearm ROM were 76.68° (range, 68-90°) in pronation and 81.75° (range, 72-90°) in supination.
Conclusions: Ilizarov technology for infected forearm nonunion can acquire satisfactory clinical results. Radical debridement is the key to control bone infection.
目的: 探讨采用Ilizarov牵张成骨技术治疗前臂感染性骨缺损的方法及疗效。.
方法: 2004年1月-2014年3月，采用Ilizarov牵张成骨技术治疗前臂感染性骨缺损患者19例。其中男12例，女7例；年龄18～62岁，平均37.4岁。初始致伤原因：交通事故伤11例，高处坠落伤4例，机器绞伤4例。曾接受1～5次手术，平均2.7次。术后发生桡骨骨不连10例，尺骨骨不连7例，尺、桡骨骨不连2例。慢性感染时间4～16个月，平均8.3个月。彻底清创后骨缺损长度2.2～7.5 cm，平均3.54 cm。C臂X线机透视下采用Orthofix单边可延长外固定支架固定。术后7～10 d开始延长，定期复查X线片了解成骨情况。.
结果: 外固定支架固定时间3～12个月，平均6.5个月；外固定指数为1.14～2.15个月/cm，平均1.72个月/cm。19例均获随访，随访时间24～55个月，平均35.4个月。骨愈合时间3～11个月，平均6个月；无感染复发。10例存在不同程度的钉道反应，但未出现严重钉道感染，未进行特殊处理，正常换药后愈合。末次随访时腕关节屈曲42～55°，平均52.78°；背伸40～60°，平均46.53°。肘关节屈曲130～150°，平均139.23°；伸展0～20°，平均3.57°。前臂旋前68～90°，平均76.68°；旋后72～90°，平均81.75°。.
结论: 采用Ilizarov牵张成骨技术治疗前臂感染性骨缺损可获得满意临床疗效，彻底清创是控制感染的关键。.
Keywords: Bone lengthening; Distraction osteogenesis; Forearm; Infected nonunion.