Med Bull Sisli Etfal Hosp. 2023; 57(2): 263-271 | DOI: 10.14744/SEMB.2023.03185

The Use of Ilizarov Method at the Lower Extremity Deformity Management

Raffi Armagan¹, Metin Kucukkaya², Haci Mustafa Ozdemir^1
1Department of Orthopedics and Traumatology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
²Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul, Türkiye

Objectives: Complications are common in the treatment of lower extremity congenital or acquired deformities by Ilizarov method. The results to be obtained vary in specific patient groups. In this study, deformities who developed before the age of 16 were compared with those developed after this age regardless of the type of aetiology, in terms of results obtained, treatment durations and complications encountered.
Methods: 53 bone deformities with an average of 9.5 (7.5-18) years of follow-up treated by the same surgeon were divided into 2 groups according to the age of deformity onset. Demographics and deformity characteristics of patients were defined, treatment times, bone healing indexes, consolidation/correction rates, problems encountered and results obtained were compared retrospectively. The results were compared with ASAMI functional and bone scoring. Complications were rated according to Paley and relative risk increases between groups were calculated.
Results: 26 of the patients were men and 22 were women. The average age was 26.47 (7-57). The mean deformity was 23.98° (7-60) and the mean shortness in 39 patients was 38.65 (10-110)mm. Mechanical axis deviation was corrected in 83% of patients. The Lengthening index was 54.13days/cm in the development group and 63.69 days/cm in adults. Consolidation/correction rate was 2.54 in developmental age and 2.4 (p=0.698) in adults. The risk increased by 1.02 times in terms of problems encountered, 2 for obstacles, 3 times in complications and 1.34 times in total difficulties per case, according to Paley. The duration of stay in the fixator was higher in developmental group (p=0.023). ASAMÝ functional (p=0.000148) and anatomical (p=0.000242) scores were better in the adult group.
Conclusion: Congenital or acquired deformities in the lower extremity can be treated with satisfactory results by Ilizarov method. The development of deformity at an early age makes treatment difficult. Although the bone healing index is lower in this group of patients, which usually has a higher amount of shortness, the treatment is usually longer than that of adult deformities; complications are more frequent and serious. Functional and anatomical results are more unsuccessful.

Keywords: Congenital tibial pseudoarthrosis, deformity, distraction osteogenesis, external fixator, fibular hemimelia, Ilizarov, length difference, lower extremity, osteotomy, physeal arrest, poliomyelitis, pseudoarthrosis

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Alt Ekstremite Deformitelerinin Tedavisinde Ilizarov Metodunun Kullanýmý

Raffi Armagan¹, Metin Kucukkaya², Haci Mustafa Ozdemir^1
1Türkiye Saðlýk Bilimleri Üniversitesi, Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Ortopedi ve Travmatoloji Kliniði, Ýstanbul
²Florence Nightingale Hastanesi, Ortopedi ve Travmatoloji Kliniði, Ýstanbul

Amaç: Konjenital veya edinilmiþ nedenli alt ekstremite deformitelerinin Ýlizarov metoduyla tedavisinde komplikasyonlar sýktýr. Elde edilecek sonuçlar spesifik hasta gruplarýnda deðiþkenlik gösterir. Bu çalýþmada etiyoloji türünden baðýmsýz, deformitesi 16 yaþ öncesi geliþenlerle bu yaþtan sonra geliþenler elde edilen sonuçlar, tedavi süreleri ve karþýlaþýlan komplikasyonlar açýsýndan karþýlaþtýrýlmýþtýr.
Gereç ve Yöntem: Ayný cerrah tarafýndan Ýlizarov metoduyla tedavi edilmiþ ortalama 9,5 (7,5-18) yýl takipli 53 kemik deformitesi, deformitenin oluþum yaþýna göre 2 gruba ayrýldý. Demografileri ve deformite özellikleri tanýmlanan hastalarýn tedavi süreleri, kemik iyileþme indeksleri, konsolidasyon/düzeltme oranlarý, ve elde edilen sonuçlar ASAMÝ fonksiyonel ve kemik skorlamasýyla retrospektif olarak karþýlaþtýrýldý. Komplikasyonlar karþýlaþýlan sorunlar Paley’e göre derecelendirilerek guruplar arasý göreli risk artýþlarý hesaplandý.
Bulgular: Hastalarýn 26’sý erkek, 22’si ise kadýndý. Ortalama yaþ 26.47 (7-57) idi. Ortalama deformite 23,98° (7-60), 39 hastadaki ortalama kýsalýk 38,65(10-110)mm idi. Mekanik aks sapmasý hastalarýn %83’ünde düzeltilebildi. Uzatma indeksi geliþim grubunda 54.13gün/cm, eriþkinlerdeyse 63.69 gün/cm idi. Konsolidasyon /düzeltme oraný geliþim grubunda 2.54, eriþkinlerde 2.4 (P = 0. 698) dü. Risk ratio, Paley’e göre karþýlaþýlan sorunlar açýsýndan 1.02, engeller için 2, komplikasyonlarda 3, vaka baþý toplu karþýlaþýlan sýkýntýlarda 1.34 kat artmýþtý. Fiksatörde kalýþ süresi geliþim grubunda eriþkinlerden yüksekti (P: 0.023 ). ASAMÝ fonksiyonel (P = 0.000148) ve kemik (P = 0.000242) skorlarý eriþkin grupta daha iyiydi.
Sonuç: Alt ekstremitede konjenital veya edinilmiþ deformitelerin Ýlizarov metoduyla tatminkar sonuçlarla tedavisi mümkündür. Deformitenin küçük yaþlarda geliþmesi tedaviyi güçleþtirmektedir. Genelde daha yüksek miktarda kýsalýk bulunan bu hasta grubunda kemik iyileþme indeksi daha düþük olmasýna karþýn tedavi genelde eriþkin çaðý deformitelerininkinden daha uzun; komplikasyonlar daha sýk ve ciddidir. Fonksiyonel ve anatomik sonuçlar daha baþarýsýzdýr. (SETB-2023-04-070)

Anahtar Kelimeler: Konjenital tibia psödoartrozu, deformite, distraksiyon osteogenezisi, eksternal fiksatör, fibular hemimeli, Ýlizarov, uzunluk farký, alt ekstremite, osteotomi, fizyal arrest, polyomiyelit, psödoartroz

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