[The possibilities for Ilizarov's transosseous osteosynthesis in treating unilateral diaphyseal fractures of the hip and leg].
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Biomedical subjects
Publications and source records attributed to S I Shved.
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Repair osteogenesis is associated with a certain pattern of change in bone tissue metabolism: metabolic processes are first enhanced continuously and, reaching a peak, grow weaker. Radioisotopic evidence demonstrates that osteogenesis is concluded within 7 to 8 weeks where the fractures involve no bone displacement, and 9 to 10 weeks where the bones were displaced by fracture.
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An experience with the treatment of 547 patients with open fractures of long tubular bones of extremities is described. The method used for the treatment of the wounds and osteosynthesis gave less amount of complications and better results of the treatment.
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Altogether 56 patients aged 20-55 with closed oblique fractures of the upper and lower limb bones were observed. Reparative osteogenesis was studied using 99mTc-pyrophosphate. An elevated RP accumulation at the ends of the bone splinters was found from the 1st day after fracture. By the end of the 1st month after fracture the RP activity increased up to 750% in the absence of splinter dislocation. In dislocation it was 50-80% less. The RP maximal activity in the place of fracture was noted on the 7-8th week, in the dislocation of splinters on the 9-10th week. By the results of radionuclide studies, the fracture consolidated right after a decrease in the 99mTc-pyrophosphate accumulation that made it possible to determine the optimum time of bone consolidation.
A total of 86 patients were examined by 99mTc-pyrophosphate in the course of therapy using the transosseous synthesis method. An elevated accumulation of the radiopharmaceutical was observed since the first day following a trauma. Maximum enhancement of metabolic processes in the absence of fragment displacement was noted on the 8th week and in the lack of displacement on the 9th-10th week. Then the intensity of bone formation got weaker. It was found appropriate that G. A. Ilizarov's apparatus should be removed exactly at that time. The content of mineral components in the regenerate was over 60% which demonstrated the bone ability to stand physiological loads.
A study was made of reparative osteogenesis and the content of mineral bone components in 60 patients with spiral fractures of the leg bones during treatment by transosseous osteosynthesis. The time of maximum labeled pyrophosphate accumulation was determined by a degree of the initial dislocation of fragments: in the dislocation to the cortical layer it was noted on the 42nd day, by 1/3 on the 45th day, by 2/3 on the 50th day, to the cross section on the 60th day. The demineralization of bone fragments in the dislocation to the cortical layer was 34%, by 1/2 37%, by 2/3 41% and to the cross section by 44%. The labeled sulphuric colloid accumulation by bone marrow cells was maximal in minimal dislocations and decreased with growing dislocation.
The experience with the treatment of 64 patients with fresh fractures of the elbow joint bones by the method of percutaneous osteosynthesis with the Ilizarov apparatus has shown its high efficiency in the treatment of such injuries.
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The article is devoted to the application of the method of perosseous osteosynthesis with the Ilizarov apparatus for the treatment of patients with fractures of the femoral and tibial condyles. The analysis of 75 clinical observations is given. Results of the treatment show the efficiency of the method.
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