Удосконалення Черезкісткового Остеосинтезу Кільцевими Фіксаторами В Лікуванні Незрощень Кісток Гомілки

Abstract

Background. Treatment of tibial nonunions is not a fully resolved problem. The use of ring fixators (RF) for this pathology is competitive in modern conditions. However, there are also disadvantages. Improvement of RF treatment technology is a promising direction for improving the results of treatment of this severe pathology. Purpose of work was to improve the results of the treatment of nonunions of the shin bones based on improving the technique of using RF taking into account the problematic issues of their use; to determine their effectiveness. Materials and methods. According to the proposed method, 42 patients with tibial nonunions were treated. Spoke-rod devices were used with the improvements we proposed — sharpening, modes of conducting and arrangement of spokes in a ring at angles in different planes. In the ring, which was used to bring the osteotomized segment down du-ring distraction osteosynthesis, the outward pins were inserted to prevent it from tipping over. Semi-closed osteotomy (minimally traumatic and safe) was performed with fan-shaped with a chisel from a cross section up to 2 cm, with the formation of a comminuted fracture. External fusion Softcast/Scotchcast allowed avoi-ding deformation of the regenerate and creating optimal conditions for the fusion of fragments. Results. The following results were obtained for the treatment of patients with nonunions of the lower leg bones using RF with our proposed modes of use according to the Modified Functional Evaluation System by Karlstrom-Olerud. Good results were obtained in 20 patients — 55.6 %. In 4 patients (11.1 %), the results were assessed as good with elements of mode-rate dysfunction. They were 22.000 ± 1.323 points. Satisfactory results were obtained in 7 patients (19.4 %), estimated at 28.0 ± 0.125 points. Bad, unsatisfactory results were observed in 1 case (2.8 %); excellent functional status — in 4 (11.1 %). Conclusions. Bearing in mind the severity of the lesion, we find this result encouraging. Given the insufficient number of observations, it is necessary to recommend the use of the proposed improvements in the use of RF for the treatment of tibial nonunions after fractures and further study of their effectiveness.