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APPLICATION OF
PROFESSOR ILIZAROV'S METHODS |
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The methods of Dr. Ilizarov from the Research Institute for
Experimental and Clinical Orthopaedics and Traumatology in
Kurgan - Rusia are accepted and carried out for 20 years at
the Special Hospital for Orthopaedics and Traumatology "St.
Erazmo" - Ohrid. These methods allow successful treatment of
the most torpid problems from the field of orthopaedics and
traumatology which were often considered as unsolvable or
whose final results were uncertain or a compromise. These
methods brought in new postulates and opened new views not
only in orthopaedics but also in the basic biological
sciences. By the acceptance of these methods the hospital's
main aim was: in the most suitable way and most rationally
to help those patients whose invalidity interrupted their
normal life, removed them for a long period of time or
permanently from public life, as individuals who work, with
unforeseeable consequences in the psychophysical sphere.
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Chronology of the
introduction of Dr Ilizarov's methods
Pseudoarthritis
Correction of
deformities
Fractures
The essence
of Ilizarov's methods
Social and economic implications
Plans for the
method
Presentation - common expirience with Ilizarov methods
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Chronology of the introduction of Dr
Ilizarov's methods |
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The beginning of our familiarization with the basic
principles of Ilizarov's methods was from professional
literature dating from the period 1976-1977.
The originality of the idea, the approach to the problems
and the results previously confirmed experimentally drew the
hospital's attention, for during its routine work it came
across identical problems every day, problems which were
difficult to solve or impossible to be solved at all. The
solution was: either to accept their approach to the
problems together with all their risks, or to agree with
partial, not always adequate, and very often forced
solutions with which neither the hospital nor the patients
were always completely satisfied. The hospital chose: the
longer and harder way respecting all known and unknown
risks. There came a period of a number of years filled with
skepticism and attention. That was also a period of
intensive studying of the theoretical postulates of
Ilizarov's methods. Unable to supply original apparatus
according Ilizarov, in 1981 the first apparatus they
constructed themselves was applied in the hospital marking
the beginning of practical work. The next goal of the
hospital was to establish as close as possible contacts with
the Kurgan Research Institute for experimental orthopaedics
and traumatology and especially with Prof. doc. G. A.
Ilizarov. Our idea was to get deeper to the heart of the
methods, i.e. to get to know the work techniques in detail.
This contact was made in 1983 for the first time when Prof.
Ilizarov visited the hospital. His visit opened a new era in
the working process of the hospital. Besides the detailed
introduction of the institute profile in Kurgan and
presentation of an impressive plead successfully treated
orthopaedic and traumatological problems, Prof. doc. G. A.
Ilizarov in the hospital also practically demonstrated his
work by operating patients.
In the years 1984 and 1986 he visited the hospital again.
This strengthened the formerly set basis for professional
collaboration between the two institutions even more. The
problems that could be solved with mutual programs were also
accepted.
His invitation for professionals from the hospital to stay
in Kurgan for further education and development of his
methods was also accepted and accomplished three times. His
stay was used not only for education (theory and practice by
mutual work, operations on patients) but also for organizing
a professional meeting in September 1986 this meeting was
attended by orthopedists and traumatologists from Belgrade,
Zagreb, Ljubljana, Sarajevo and Skopje. Then they constitute
a group that would work within the framework of YUOT and
would deal with objectivization of Ilizarov's methods here,
and exchange experiences related to the problems solvable by
these methods. The registration of the group under the name
of YUOT was the next activity. As a coordinator of this
group they appointed the Special Hospital for Orthopaedics
and Traumatology Ohrid. That was also a special credit
for all past efforts concerning the acceptance of Ilizarov's
methods. An this meeting they suggested that the hospital in
Ohrid become a center with a wider Yugoslav meaning for the
application of Ilizarov's principals, which was also
accepted.
In order to justify its trust and respect in the
professional and medical circles the Special Hospital for
Orthopaedics and Traumatology - Ohrid, towards the end of
the seventies, made a distribution of professional work
according individual problems, i.e. created
multidisciplinary teams for strict direction of personnel to
individual problems. In this context, in 1982 they created a
group at the Hospital that would study the methods and
details of the techniques of work. In addition to the
orthopedists, in this group they also included a physiatrist
and a neurologist. |
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Pseudoarthritis |
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Pseudoarthritis (false joints, difficult healing after bone
fractures or congenital false joints). Modern transport
means, the expansion of transport traumatisms and the
growing number of developing anomalies increase the problem
of false joints.
The former methods of treatment of sue patients did not
completely solve problem. This especially applies to the
infected pseudoarthritis, which is increasing along side
with the osteosynthesis shorter or deformed extremity as a
consequence. In addition to the two well-known components
that are present in these cases of pseudoarthritis
(difficult healing and infections), Ilizarov himself also
adds the problems of shortening and deformation of the
extremity. Respecting his principles, the approach to this
problem was significantly changed. This enabled curing of
pseudoarthritis, elimination of the infection, correction of
the axis and saving, i.e. reaching of normal length of the
extremity, all in one or two phases with minimal
multilateral undertakings on the altered extremity. The
final results from the treatment of such patients completely
justify the orientation of the hospital to apply Ilizarov's
methods. |
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Correction of deformities |
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The deformities of the extremities, of any kind of genesis,
have a negative effect on the statics of the complete
locomotor apparatus. No matter whether they are acquired
(most often post traumatic) or congenital deformities of the
skeleton, Ilizarov's method, which is based on successive
and gradual solving of the problem, gives extraordinary
results, which from experience, are also proven by the
Special Hospital for Orthopaedics and Traumatology-Ohrid. |
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Fractures |
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Fractures (broken, traumatological or pathological) are the
next symptomatic regions of application of his methods. This
especially applies to two difficult problems in the
orthopaedics and traumatological practice: pathological
fractures and open fractures. The work principle is dynamic
extra focal fixation (osteosynthesis). Despite the hidden
dangers that this problem brings with itself, Ilizarov's
method found its place and is increasingly being transformed
from an alternative to a dominant method in the solving of
this problem. This does not exhaust indications for
application of Ilizarov's principles. We have merely listed
the most frequent, and at the same time the most
therapeutically resistant problems. |
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The essence of Ilizarov's methods |
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Based on present knowledge in the field of biomechanics,
Prof. dr. G. A. Ilizarov " was making his own system for
treating not only the problems from the field of
orthopaedics and traumatology, but also from the field of
vascular and plastic surgery (treatment of obstructive
vascular illnesses from the type of Birger) or replacement
of defects on soft tissues (muscles, fascia, blood vessels
and nerves) and covering defects with skin covers without
using transplantations on these tissues. The adoption and
adaptation of natural (biological) laws, and not their
rejection, are used as basic regular laws. |
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The basic principles on which Ilizarov's study is based, and
at the same time his most striking advantages compared to
the classical methods, are the following:
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• Minimal traumatization of the soft tissues (small
skin cut during operation, from 1 to 2 cm, no division of
muscles and injury on blood vessels and nerves), there is no
deperiostation of the bone;
• Corticotomy (cutting only the corticortal layer of
the bone arid protection of the bone and medular contents
which are also the source of osteogenetic potential);
• Sparing of vascular elements extra and intraosal;
• Rigid dynamic fixation (osteosynthesis), achieved by
net-like transfixation of the bone segment using thin
needles placed in cases when there is overstraining;
• Early mobilization of neighboring joints;
• Total load on the operated extremity from the first,
i.e. the second post operative day. This frees the patient
from long-lasting stay in bed or carrying plaster.
Practically, this means that the patient whose extremity is
being elongated, if it is done using one of the classical
methods, would have to undergo at least three big operations
(elongation, spongioplastics plus osteosynthesis and removal
of osteosynthetic materials). We have to emphasize that this
kind of undertaking is conditioned by the pathology, age and
working technique, and making of longer elongations would
not be possible. In addition o this, the patient would have
to be tied to bed for months subject to all risks of
repeated operations and long-lasting stays in bed or limited
locomotion of neighboring joints. Using Ilizarov's method,
when the patient can move around with total strain on the
extremity from the very first day, all previously mentioned
risks are brought to a minimum, making it possible to work
on adult patients and to achieve considerably longer
elongations.
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To conclude, we can freely say that the method of transosal
synthesis together with the apparatus for skeletal
transfixation, according Ilizarov, opens wide horizons in
the overcoming of the problems of invalidity in an extremely
rational manner. |
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Social and economic implications |
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Knowing the material conditions in our economy and in
general, especially in the medical field, the application of
Prof. Dr. G. A. Ilizarov's method significantly rationalizes
the material expenses for the treatment of orthopaedic and
traumatology patients. It is well known that this treatment
is among one of the most expensive and one of the longest
being connected with a number of material expenses which are
not to be disregarded. This method not only allows
shortening of the time needed for hospitalization, but also
allows repeated usage of a large number of comprising parts
of Ilizarov's apparatus on a larger number of patients.
On the other hand, the caused invalidity, most often, from
the epidemic of traffic traumatism and its consequences
causes a great problem, for it burdens the economy funds.
Most often they are patients who are at the beginning or are
in their late working stage. A fast treatment and a fast
return of the patient to work is an imperative of every
modern treatment. This method not only allows fast medical
and professional rehabilitation, but it also allows clinical
treatment of patients for whom it was previously thought
that they could only be treated under strict and complete
hospitalization.
We feel that the collaboration with the renowned institute
for experimental and clinical orthopaedics and traumatology
in Kurgan opened for us, among the first in Europe, new
knowledge in solving problems that only till yesterday
seemed very difficult and insoluble.
For the first time in the worldwide orthopaedics practice
these problems became solvable. Problems such as liquidation
of shortening of extremities, above 50% of the original
length of the extremity, and more, on children as well as on
adults, were treated using bloodless means without surgery.
For the first time it was possible without transplantation
of bone to treat significant defects on the skeleton, false
joints, to regulate growth, to thicken the bone and to treat
a number of congenital illnesses. All this provides grounds
for lowering of invalidity up to six times.
For the first time, using the biological potentials of the
bone tissue, there was success in influencing the process of
remodeling the bone into the desired direction.
The respect that the Special Hospital for Orthopaedics and
Traumatology from Ohrid gained abroad for using this method
is confirmed by the visit of the "Kalo" Institute in France,
where our team demonstrated practical application of
compressive and destructive apparatus according to Ilizarov
on their patients.
We believe that we are one of the many, and certainly among
the first centers in Europe who incorporated Ilizarov's
methods in their every day routine work. The system of
clinical treatment of patients by the given method that we
are using, allows restoration of working capabilities on a
significant number of ill people and lowers the expenses
compared to hospital treatment. The affirmation of this
method is significant not only from the medical point of
view, but from a social and economic aspect as well. |
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Plans for the method |
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The professional team working on this problem plans the
following:
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• To follow actively everything new that comes out of
the Kurgan institute;
• To increase frequency of mutual meetings between
professionals from the Institute in order to evaluate past
activities, exchange experiences on certain thematic
problems and organize joint activities on given programs;
• Working out of previously set problems, problems
that need clinical approbation (meaning, first of all, the
problem on deformation of the spinal column);
• Complex statistic analysis for our past work;
• Introduction of new scientific methods on patients
treated by the method (angiography, computer
tomography, subtle laboratory analyses concerning fig
general reaction of the organism treated by the method of
Ilizarov, pato-hystic and chemical analyses etc.);
• Clinical application of an automatic distracter;
• Multidisciplinary activities by including
institutions that deal with basic biological activities;
• Detailed examination of the biochemical
characteristics of the system apparatus-bone. |
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