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ILLRS Historic Background  

2015-05-18 17:15:08|  分类: 骨科英语 |  标签: |举报 |字号 订阅

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History of External Fixation
Almost 2400 years ago Hippocrates described a form of external fixation to splint a fracture of the tibia. The device consisted of closely fitting proximal and distal Egyptian leather rings connected by four wooden rods from a cornel tree.

ILLRS  Historic Background - 小骨头 - 小骨头的博客

In 1840, Jean-Francois Malgaigne described a spike driven into the tibia and held by straps to immobilise a fractured tibia. In 1843 he used a claw-like device to percutaneously hold the fragments of a fractured patella.




ILLRS  Historic Background - 小骨头 - 小骨头的博客

Clayton Parkhill of Denver, Colorado and Albine Lambotte of Antwerp, Belgium independently invented the modern concept of unilateral external fixation, in 1894 and 1902, respectively. Lambotte was the first to use threaded pins, however, his device necessitated initial, open fracture reduction and then pin insertion and fixator placement.




ILLRS  Historic Background - 小骨头 - 小骨头的博客

In 1938, Raoul Hoffmann of Geneva, Switzerland, building on the work of others, realized that major improvements were essential to make the external fixator more clinically relevant. He developed a technique based on closed reduction with guided percutaneous pin placement. Hoffmann’s technique exemplified the first application of minimally invasive orthopaedic surgery.



ILLRS  Historic Background - 小骨头 - 小骨头的博客

In the 1950s, Gavriil Ilizarov of Kurgan, Soviet Union, devised and developed a new method for treating fractures, deformities and other bone defects. A metal frame that encircles the limb is attached to the underlying bone by crossing (X) wires inserted through the bone and limb. The external rings are linked to each other by threaded rods and hinges that allow to move the position of the bone fragments without opening the fracture site, then the fragments can be fixed in rigid position until complete healing.


History of Distraction Histogenesis

The history of surgical limb lengthening dates back to the turn of the 20th century when Codivilla published the first article on this subject in the American J. Orthop. Surg Vol 2, 1904-5. While he used a gradual traction system, his successor Putti and others began using external fixation to lengthen limbs. Putti and others recognized that bone could be regenerated by distraction.  

Through the 1930’s, 40’s and 50’s various external fixation devices were developed to lengthen limbs (Dickson 1932, Haboush 1932,Abbot 1939, Allan 1948, Anderson 1952). Even the concept of lengthening over a nail was introduced in 1956 by Bost. All authors used distraction osteogenesis as the means of bone regeneration. Various osteotomies were used including Z shaped.  Emphasis was placed on minimal invasive osteotomy for better bone regeneration. 

Circular external fixation for use in fracture treatment dates back to Bitner in the 1930’s, Mendoza 1946 and Witmosser 1949.  Ilizarov patented his device in 1951. His methods and devices remained relatively unknown in the West until the 1980’s.  In the 1960’s and 70’s the prevalent method in the West was the Wagner technique. This method frequently led to failure of bone formation due to an open osteotomy, periosteal transaction, acute diastasis and 2mm per day distraction rate.  The frequent disasters from the Wagner method gave  limb lengthening a bad reputation that is remembered to this day.

 Ilizarov deserves credit for identifying the factors that are important to bone and soft tissue regeneration and to applying basic science to this field. Few others with the exception of Kawamura from Japan contributed to the science of  limb lengthening in those days. Ilizarov’s method reached national attention in the USSR when he 

ILLRS  Historic Background - 小骨头 - 小骨头的博客successfully repaired the infected tibial nonunion of Valeri Bruml the Soviet Gold Medal High Jumper. He remained in obscurity outside the USSR until a media campaign in 1972 in which he was described as the Magician of Kurgan. Prof. Monticelli from Rome was asked to comment on the Soviet  limb lengthening  achievements.  He assigned his assistant Renato Spinelli to research this.  Spinelli began animal experiments on physeal distraction based on Ilizarov’s publications. He received a scholarship from the Italian Othopedic Association to visit Ilizarov. He went in 1980 and learned that corticotomy for lengthening was the preferred method in Kurgan. He published articles on this method in the Western journals. Despite Spinelli the world did not learn much regarding Ilizarov. 

It was not until a serendipitous connection between an Italian photojournalist-explorer Carlo Mauri and his orthopedic surgery friendAnglo Villa from Lecco that the Ilizarov method came to Italy.  Mauri learned of Ilizarov from a Russian physician on the Tigris expedition of Thor Heyerdahl in 1978.  He journeyed to Kurgan and was treated in 1980.  His friends in Lecco Italy learned of Ilizarov from Mauri’s stories and pictures. They invited Ilizarov to Lecco in 1981 for an AO conference on bone infection. The Italian group including CattaneoBianchi-Maiocchi, Benedetti, Vila and Catagni, voyaged to Kurgan later that year.  In 1983 Bianchi-Maiocchi signed and agreement with the Soviet Licensing Body to manufacture and commercialize the Original Ilizarov Fixator in Italy.  This critical event ensured a continuation of the academic exchange between Kurgan and Western Europe. 

Another Italian group in Verona (DeBastiani and Aldegheri) developed an mono-lateral external fixator for fracture treatment that was then adapted for limb lengrhening by Orthofix.  They adapted Ilizarov’s new concepts to this monolateral external fixator showing that it was not the device but the method of gradual distraction of a low energy osteotomy that was important for bone regeneration. The Wagner device was later adapted by Canadel and DePablos in Spain, in the same way and proven to regenerate bone as long as the Ilizarov biologic principles were adhered. In addition to limb lengthening, bone transport, nonunion distraction, joint distraction and many other techniques were introduced to Western Europe because of the Ilizarov connection. 

In 1982 the Italians founded the Association for the Study and Aplication of the Method of Ilizarov (ASAMI), and latter various ASAMI’s were created in different countries of Europe, and then troughtout the world.  A few years later ASAMI International was founded by Roberto Cattaneo. Its first meeting was held in New Orleans. Since the 1980’s many publications, courses and conferences on this subject have been presented. The scientific work of the Soviets has been reproduced and expanded upon.

In 1990 Paley began Lengthening over Nail (LON) published in 1997. Nail lengthening is not new. It dates back to Bost in 1956.  Fully implantable nail lengthening was first reported on by Alexander Bliskunov from Sinferopel, Ukraine in 1983. Guichet begun doing nail lengthening with its fully implantable Albizzia nail in 1990, followed by Baumgard and Betz with the Fitbone motorized nail and Colewith the ISKD nail. The era of implantable limb lengthening is here and many more devices are expected (e.g. Orthogon-Israel, Phenix-France). 

Distraction histogenesis concepts have now expanded to other fields in particular cranio-maxillo-facial surgery and spine surgery with many new innovative devices. 

Growth factors and pharmacologic modulation of bone healing is now in research stage and may play a role in the bone and soft tissue healing of limb lengthening.

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