髂嵴前部揭盖式内板取骨术

目的：探讨改进髂嵴前部取骨术式。方法：保留髂嵴顶部薄骨片及骨膜蒂切取髂骨，取骨后带蒂骨片恢复原位；该术式与传统取骨组病例比较。结果：改进术式组保留了髂嵴解剖完整性，侵入性损伤小，并发症少，是较为理想的取髂骨方法。     

髂嵴人字式取骨术的临床应用

目的改进髂嵴大量取骨术式,减少术中术后出血。方法 2007—2012年作者采用髂嵴取骨术,行四肢陈旧骨折植骨107例,其中髂嵴人字式取骨组61例,男性41例,女性20例;年龄18~65岁,平均32岁。传统髂嵴前部取骨组(即骨膜下电刀剥离后凿取骨板,术毕分层关闭伤口)共46例,男性30例,女性16例;年龄17~59岁,平均31岁。记录术中出血量、手术时间及术后并发症。结果所有患者随访12~36个月,平均18个月。传统方法组:4例血肿形成,2例腹内容物疝出,1例表浅感染,3例髂骨供骨区慢性疼痛,并发症发生率为21.74%。人字式取骨组:术后1例供骨区血肿形成,2例供骨区疼痛,并发症发生率为4.91%。统计学(χ2检验)分析结果表明:髂嵴人字式取骨术组并发症发生率明显降低(α=5.115,P0.05)。结论改进术式组保留了髂嵴顶部解剖完整性,侵入性损伤小,出血量少,术后并发症发生率低,是取髂骨较为理想的方法。     

保留髂骨外形与传统髂骨取骨术的病例对照研究

目的:观察传统髂骨取骨和保留髂骨髂嵴两种取骨方式在自体植骨手术中的应用并探讨其有效性和安全性。方法：自2016年1月至2018年12月50例需行自体植骨患者分别采用传统髂骨取骨方式和保留髂骨髂嵴取骨方式进行髂骨取骨,每组25例,其中传统髂骨取骨组,男18例,女7例,年龄（42.0±7.9）岁,住院时间（20.0±5.5） d,随访时间（13.68±1.60）个月;保留髂骨髂嵴取骨组,男16例,女9例,年龄（44.0±8.2）岁,住院时间（21.0±6.5） d,随访时间（14.04±1.54）个月,比较两组患者取骨手术时间,术中出血量,术后疼痛视觉模拟评分（visual analogue scale,VAS）,观察骨折愈合情况以及并发症。结果：传统髂骨取骨组手术时间为（16.20±2.51） min,术中出血量（63.20±17.73） ml,术后第1天VAS评分为4.72±1.21,骨折愈合时间（4.84±0.90）个月。保留髂骨髂嵴取骨组手术时间为（16.24±3.00） min,术中出血量（62.80±18.14） ml,术后第1天VAS评分为4.80±1.29,骨折愈合时间（4.68±0.80）个月。两组的手术时间、术中出血量、术后第1天VAS评分、骨折愈合时间比较,差异无统计学意义（P>0.05）。结论：与传统髂骨取骨手术相比,保留髂骨外形的取骨方式,简单方便,在保证取骨量的同时,尽可能的保留了髂骨的髂嵴外形,减少术后局部不适症状,值得推广。     

微创定点髂后棘取骨的临床研究

目的探讨微创定点髂后棘取骨的可行性及临床效果。方法 2012年6月至2018年5月收治需植骨的骨延迟愈合、骨不连患者40例,随机分为实验组和对照组,每组20例。实验组采用微创定点髂后嵴取骨,对照组采用传统开放性取骨。统计并分析两组的手术时间、手术切口长度、术中出血量、术后并发症发生率等,并随访植骨后治疗骨延迟愈合、骨不连的骨愈合情况。结果 a)实验组:手术时间为(15.70±3.61)min,手术切口长度(1.42±0.28)cm,手术出血(16.05±4.72)mL,术后伤口均Ⅰ期愈合。局部血肿是唯一的并发症,3例患者出现局部血肿,均可自行消退,无严重并发症发生。对照组:手术时间(37.90±4.99)min,手术切口长度(5.02±0.50)cm,手术出血(49.50±8.72)mL,术后2例出现伤口感染、愈合不良,2例出现股外侧皮神经损伤,3例出现取骨部疼痛,2例出现髂骨凹陷。b)两组手术时间、切口长度及手术出血对比,实验组显著低于对照组(P0.01)。术后并发症的发生率等比较差异有统计学意义(P0.05),两组植骨后治疗骨延迟愈合、骨不连的骨性愈合率差异无统计学意义(P0.05)。结论微创定点髂后棘取骨与传统开放性取骨,均可达到自体髂骨移植的目的,但微创定点髂后棘取骨具有手术损伤小、出血少、操作简便、并发症少等优点,值得临床推广。     

髂骨翼内板入路开窗松质骨采取法

1994～1997年,我们在28例34侧先天性齿槽嵴裂患儿(6～14岁)利用自体骨移植修复术中,应用髂骨翼内板入路开窗采取松质骨的方法,取得良好效果。1　手术方法患儿取仰卧位,右髂稍垫高。在皮肤上标出髂前上嵴的位置,在其后2ｃｍ为起点,于髂嵴内侧15ｃｍ设计一与髂嵴平行的长度约为5ｃｍ的切口。切开皮肤和筋膜,将切口拉向外侧,暴露髂嵴。切开少量腹内斜肌、腹横肌和髂嵴软骨帽表面的骨膜,将骨膜从软骨和髂窝表面钝性剥离后,在骨膜中部垂直剪开紧张的软骨膜和骨膜,暴露足够大的内板骨面,在骨面上设计一大小约为4ｃｍ×2ｃｍ的矩形骨窗,其上边距髂…     

改良切口取髂骨121例治疗体会

髂骨取骨术是常见手术,虽然手术小,但其术后并发症比较多,如果不加以重视,给病人造成的痛苦很大,应该引起临床医师的重视。其最常见的并发症就是疼痛、腹胀、神经损伤、血肿、髂骨骨折及感染。自１９９２年１０月至１９９８年１０月,我们对手术切口给予改良,术后并发症明显减少,术后随访满意,现报告如下：临床资料一、一般资料本组１２１例,男８１例,女４０例,年龄２１～６５岁,平均４１岁。随访时间１～６年,病例全为髂骨前段取骨。二、治疗方法传统的切口是从髂前上棘沿髂嵴的皮下缘向后作皮肤切口,而我们将手术切口给予改…     

髂骨取骨术后并发症及其防治

髂骨取骨术是常见手术,但有关其并发症的报告较少,可能与对这些并发症不够重视有关。我们随访到1984年10月～1992年7月各种原因行髂骨取骨术的520例,结合文献就引起并发症的原因及防治方法进行了初步分析。 1 临床资料 1.1 一般资料 520例中,男346例,女174例,年龄14～81岁,平均47岁9个月。随访时间1～8年9个月。髂嵴前段取骨438例,髂后嵴全厚取骨69例,单纯取松质骨而保留内外板取骨者31例。 1.2 术后并发症 股外侧皮神经损伤27例,髂腹股沟神经损伤2例,臀上神经损伤3例。疼痛21例,血肿8例,髂骨骨折5例,感染3例。     

Stoppa入路在髋关节发育不良髋臼周围截骨术中的应用

 目的 探讨Stoppa入路联合髂嵴切口应用于髋关节发育不良髋臼周围截骨术的安全性及有效性。方法2011年9月至2012年7月接受髋臼周围截骨术中应用Stoppa入路的髋关节发育不良患者18例20髋,女15例17髋,男3例3髋。患者年龄19~35岁,平均29岁。手术切口采用腹部横切口（即Stoppa入路）联合髂嵴切口（髂腹股沟入路的外侧窗）。记录手术时间、切口长度、术中出血量和异体血输血量,术后12个月门诊随访时评估髋关节功能、影像学征象和手术相关并发症。结果 手术时间125~180 min,平均145 min。Stoppa入路腹部横切口长5~10 cm,平均7 cm;髂嵴切口长4~8 cm,平均6 cm;切口总长度为12~16 cm,平均13 cm。术中出血量为500~1 600 ml,平均800 ml;异体血输血量为400~2 400 ml,平均1 161 ml。术后随访14~22个月,平均19.6个月。Harris髋关节评分由术前（80.3±8.5）分改善至术后12个月时（93.5±5.2）分,平均改善（13.2±6.0）分;中心边缘角由术前7.5°±5.4°改善至30.0°±4.6°,平均改善22.5°±4.5°。手术前后Harris髋关节评分与中心边缘角的差异均有统计学意义。全部截骨均愈合,愈合时间3~6个月,平均3.3个月。2髋耻骨支截骨延迟至术后6个月愈合。3例术后出现一过性股外侧皮神经麻痹,未予特殊处理。结论 Stoppa入路联合髂嵴切口能够安全有效地完成髋臼周围截骨术,可以代替传统的髂腹股沟入路用于无须髋关节探查的轻度髋关节发育不良患者。     

不同髂骨供区取骨后并发症随诊分析

髂骨是自体骨移植的最好供区,髂骨取骨术是常见手术。自1982年7月19977月采用髂前、髂后嵴为供骨源取骨共406例,通过3月～3年随访,发现并发症55例,且髂后嵴区并发症较髂前区少。现结合文献,分析如下。 临床资料 一、一般资料:本组406例,其中男325例,     

经皮微创松质骨取骨器的研制及临床应用

目的探讨自制微创取骨器在髂骨取骨的临床应用效果。方法2007年2月～2008年10月采用自行研制的微创取骨器取松质骨35例,自髂前上棘后1cm至髂嵴结节髂骨较厚的区域取骨。结果取骨量1～4cm3,平均2.37cm3;微创取骨器取骨的操作时间3～5min;出血量1～2ml;并发症发生率5.7%（2/35）。结论使用微创取骨器取松质骨,方法可靠,可满足部分植骨手术的需要。     

Harvesting bone graft from the posterior iliac crest by less traumatic,midline approach

Complications of the donor site after the harvest of corticocancellous bone graft from the posterior iliac crest are very common. The most common are chronic donor site pain, tenderness, and sensory disturbances. This study investigates the results of the midline, lumbar fascia splitting approach for harvesting bone graft in lower lumbar spine fusion and compares them with the classic separate incision approach. A retrospective study of 107 patients compares two groups. The first group of 56 patients (35 males and 21 females with an average age of 41.8 years) had bone graft taken by splitting the two layers of the lumbar fascia down to their attachment to the iliac crest. The second group of 51 patients (29 males and 22 females with an average age of 43.7 years) had a separate incision over the iliac crest. In the first group, 82.1% had no tenderness, 8.9% mild, 7.1% moderate, and only 1.8% severe tenderness over the donor site. In the second group, 45.1% had no tenderness, 21.6% mild, 17.6% moderate, and 15.7% severe tenderness over the donor site. Five patients of the separate incision group (9.8%) had a lump in the donor site compared with none in the "same incision" group. Sensory disturbances over the donor site were found in 5.4% of the first group and in 21.6% of the second group. Harvesting bone graft from the posterior iliac crest for lower lumbar spine fusion through a midline, fascia splitting approach was found superior to the traditional, separate incision approach.     

Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes

BACKGROUND: Previous studies have demonstrated high complication rates after harvest of iliac crest bone grafts. This study was undertaken to compare the morbidity related to the harvest of anterior iliac crest bone graft with that related to the harvest of posterior iliac crest bone graft and to determine differences in functional outcome. METHODS: The medical records of eighty-eight consecutive patients who had undergone a total of 108 iliac crest bone-grafting procedures for the treatment of chronic osteomyelitis from 1991 to 1998 were retrospectively reviewed. Demographic characteristics, the location of the harvest, the volume of bone graft that was harvested, the estimated blood loss, and postoperative complications were recorded. Fifty-eight patients completed a questionnaire pertaining to postoperative and residual pain, sensory disturbances, functional limitations, cosmetic appearance, and overall satisfaction with the bone-graft harvesting procedure. RESULTS: Sixty-six anterior and forty-two posterior bone-graft harvest sites were evaluated at a minimum of two years after the operation. A major complication was associated with 8% (five) of the sixty-six anterior sites and 2% (one) of the forty-two posterior sites. The rates of minor complications were 15% (ten) and 0%, respectively. In the series as a whole, there were ten minor complications (9%) and six major complications (6%). The rates of both minor complications (p = 0.006) and all complications (p = 0.004) were significantly higher after the anterior harvest procedures than they were after the posterior procedures. The postoperative pain at the donor site was significantly more severe (p = 0.0016) and of significantly greater duration (p = 0.0017) after the anterior harvests. No patient reported functional limitations at the latest follow-up evaluation. CONCLUSIONS: In this series, the complication rate was lower than those previously reported by other investigators. Harvest of a posterior iliac crest bone graft was associated with a significantly lower risk of postoperative complications. On the basis of the results of this study, we recommend that iliac crest bone graft be harvested posteriorly whenever possible.     

A modified technique for harvesting full-thickness iliac crest bone graft

STUDY DESIGN: A prospective follow-up study of patients undergoing anterior spinal decompression and bone graft with cortical iliac crest bone. OBJECTIVE: To describe a modified technique for harvesting cortical bone graft from the anterior iliac crest. SUMMARY OF BACKGROUND DATA: Cortical bone graft from the iliac crest frequently is used in various orthopedic and spinal procedures. The resulting defect in the iliac crest has been associated with many complications. METHODS: Twenty patients were included in this study. All had burst vertebral fracture requiring anterior spinal decompression and cortical bone grafting. The modified technique was used for harvesting the iliac crest bone graft in all patients. RESULTS: All patients were satisfied with the appearance of the iliac crest. None reported chronic pain at the graft site. None had fracture of the iliac wing, and none had symptoms related to the lateral femoral cutaneous nerve or herniation of pelvic contents through the bony defect in the iliac wing. CONCLUSION: This modified technique is technically straightforward and cost-effective. It preserves the contour and shape of the iliac crest and avoids cosmetic deformities and chronic pain at the graft site. It creates a window in the iliac wing rather than disrupting the continuity of the iliac crest, which leaves the iliac wing structurally stronger than with currently used techniques.     

青少年特发性脊柱侧凸患者后路髂棘处取骨植骨并发症

目的探讨青少年特发性脊柱侧凸患者后路髂棘处取骨并发症的发生率。方法对1999～2002年201例后路取髂骨行脊柱植骨融合术的青少年特发性脊柱侧凸患者进行回顾性研究。其中85例患者获得随访，最短随访时间为2年。结果住院期间有2例发生局部感染，通过灌洗引流和清创得到恢复。1例发生髂骨内板穿透，未引起临床症状。3例发生持续性疼痛，1例发生麻木。总的并发症发生率为3。5％。在随访的85例患者中，21例(24。7％)有髂棘取骨处疼痛，其中13例(15．3％)影响日常生活。7例(8．2％)需要服用非甾体类抗炎药以缓解取骨部位疼痛。6例(7.1％)瘢痕周围的皮肤感觉过敏，15例(17．6％)有瘢痕周围皮肤麻木。结论尽管青少年脊柱侧凸患者住院期间髂棘取骨处并发症较低，但经过长期随访，疼痛及麻木的并发症明显增高，应值得更多关注。     

Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review

Bone grafting is a commonly performed surgical procedure to augment bone regeneration in a variety of cases in orthopaedic and maxillofacial surgery. Autologous bone graft remains to be the 'gold standard' and the iliac crest to be the most common harvesting site. The intramedullary canal of long bones represents another potential site for large volume of autologous bone graft harvesting and is recently being used as an alternative donor site. However, harvesting of autologous bone graft is associated with morbidity and a number of complications. The aim of this systematic review was to collect and summarise the existing data on reported complications after harvesting autologous bone from the iliac crest (anterior and posterior) and the long bone intramedullary canal using the RIA device. We searched the PubMed Medline and Ovid Medline databases, from January 1990 to October 2010, to retrieve all relevant articles. A total of 92 articles (6682 patients) were included in the analysis. Overall, the complication rate following RIA was 6% (14 complications in 233 patients) and 19.37% after iliac crest bone graft harvesting (1249 complications in 6449 patients). The rate of each of the reported complications was assessed and, when the donor site was properly documented, comparison within the anterior and posterior iliac crest donor sites was performed. Although the difference of the overall morbidity rates between the two harvesting sites was not statistically significant (p=0.71); the rates of certain complications were found to significantly differ when anterior or posterior iliac crest was used. The rates of infection (p=0.016), haematoma formation (p=0.002), fracture (p=0.017), and hyperthrophic scar (p=0.017) were significantly higher when the donor site was the anterior iliac crest compared to the posterior iliac crest; whereas the rates of chronic donor site pain (p=0.004) and sensory disturbances (p=0.003) were significantly lower. The incidence of bone graft harvesting related complications can be reduced further if certain principles are followed depending on the performed harvesting methods; but overall the use of RIA device as harvesting method seems a promising alternative with a low complication rate.     

Complications of posterior iliac crest bone grafting in spine surgery in children

STUDY DESIGN: The perioperative and postoperative complications associated with harvesting posterior iliac crest bone graft in children were reviewed. A retrospective study was performed and a questionnaire interview conducted. OBJECTIVES: To determine the morbidity associated with posterior iliac crest bone graft in children. SUMMARY OF BACKGROUND DATA: Iliac crest bone is commonly used as a source of bone graft in spine surgery. Although there are multiple reports of complications in adults, there are no reports in children. METHODS: A retrospective chart review was performed of 214 consecutive children who underwent spinal fusion with posterior iliac crest bone graft from 1990 through 1996. An interview was conducted of 87 patients with normal mental status, predominantly those with idiopathic scoliosis with a minimum of 2 years' follow-up (mean, 55 months). RESULTS: The review showed one (0.5%) instance of arterial injury in the sciatic notch. Two (1%) patients had infections, both of which resolved with a single irrigation and débridement. There was one documented instance of sacroiliac penetration that did not cause clinical problems. The chart review showed three (1.4%) instances of continued pain and one (0.5%) of numbness. By contrast to the few reports of pain in the chart review, responses to an interview of 87 patients showed 21 (24%) children reporting pain at the iliac crest site, with 13 (15%) reporting problems with daily activities. The self-reported pain, on a scale of 1 to 10, ranged from 1 to 10 with a mean of 4. Nonsteroidal anti-inflammatory drugs (NSAIDS) were taken by eight (9%) children for pain at the bone graft site. Five (6%) reported skin irritation, and 18 (20%) mentioned numbness surrounding the scar. CONCLUSION: The perioperative rate of complications in iliac crest bone grafting in children is low (2%). The complication of pain (24%) and pain that is severe enough to interfere with daily activity (15%) is significant at a mean follow-up of more than 4 years. The true extent of pain and numbness after posterior iliac crest bone grafting in children was severely underreported in the medical records and may be underrecognized.     

人工骨联合自体骨髓移植技术的骨缺损修复研究与应用

目的分析人工骨联合自体骨髓移植技术治疗骨缺损的临床疗效。方法选取2011年4月至2013年9月,来本院诊治的四肢粉碎性骨折术后骨缺损患者40例,随机分为两组（A、B组）,分别行自体髂骨植骨和人工骨联合自体骨髓移植治疗四肢粉碎性骨折所致骨缺损。术后观察两组骨折愈合时间,骨折愈合率,并发症的发生及骨缺损的修复和功能重建优良率。结果两组均行6～12个月随访,平均（9.14±1.36）月,所有患者植骨术后均无切口感染、发热等并发症。A组15例骨缺损区愈合良好,住院时间平均（19.36±2.54）天,骨折愈合时间平均（5.67±1.52）个月,骨缺损的修复和功能重建评价标准,优12例,良3例,可3例,差2例,优良率75%;B组18例骨缺损区愈合良好,住院时间平均（12.19±1.52）天,骨折愈合时间平均（3.61±1.13）个月,骨缺损的修复和功能重建评价标准,优16例,良2例,可2例,差0例,优良率90%。B组骨缺损治疗效果显著优于A组。结论人工骨联合自体骨髓移植较单纯自体髂骨移植治疗骨缺损更能促进骨痂生长,加速骨折后骨缺损愈合,更加有效地减少住院时间及骨折愈合时间,骨折愈合率更高,骨缺损修复和功能重建效果更加显著。     

Arteriovenous fistula of the superior gluteal artery as a complication of posterior iliac crest bone graft harvesting: 3D-CT angiography and arterial embolization

Superior gluteal artery injuries are rare, but potentially serious complications that occur during posterior iliac crest bone graft harvesting. The authors reported an arteriovenous fistula of the superior gluteal artery, which occurred as a complication during posterior iliac crest bone graft harvesting and was diagnosed with 3D-CT angiography, then treated with arterial embolization.     

Conversion of the monocortical iliac bone graft to the three-dimensional prism bone graft

INTRODUCTION: The iliac crest is the most common bone graft donor site. However, harvesting of tri or bi-cortical iliac bone graft is associated with some potentially serious complications and cosmetic deformity. We would like to present a case in which we used a new technique converting the mono-cortical iliac graft to the three-dimensional prism bone graft in order to reconstruct an acquired first metatarsal defect and to avoid the potentially serious complication of the iliac crest bone harvest. CASE REPORT: A six-year-old boy was referred to our institution due to the posttraumatic deformity of his left foot. He had a short big toe and dorsoflexion contracture of first metatarso-phalengeal joint due to the first metatarsus defect and previous skin graft. To reconstruct the bony defect, 4 x 3 cm monocortical bone graft was harvested from the anterior aspect of the ilium by using the peel-off technique. Then, the mono-cortical graft was converted to the prism with the appropriate osteotomies. This custom shaped tri-cortical prism bone graft was placed into the first metatarsal defect. Lateral arm fascia-cutaneous free flap was used for soft tissue reconstruction. The patient was able to walk without support and wear regular shoes and started playing freely with his friends at four months after the reconstruction. CONCLUSION: This is a single case report and demonstrates that a successful result can be obtained with this technique. Although the prism bone graft technique seems to offer a solution to a potential rather than a real problem, it offers a thick and three-dimensional cortico-cancellous bone graft without violating the iliac crest. Thus, the risk of serious complications resulting from the tricortical iliac crest graft or bicortical full thickness graft harvesting can be eliminated. Moreover, epiphysis of the immature iliac crest can be preserved in a growing child.     

Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis

There are few reports on the treatment of pyogenic lumbar spondylodiscitis through the posterior approach using a single incision. Between October 1999 and March 2003 we operated on 18 patients with pyogenic lumbar spondylodiscitis. All underwent posterior lumbar interbody fusion using an autogenous bone graft from the iliac crest and pedicle screws via a posterior approach. The clinical outcome was assessed using the Frankel neurological classification and the criteria of Kirkaldy-Willis. Under the Frankel classification, two patients improved by two grades (C to E), 11 by one grade, and five showed no change. The Kirkaldy-Willis functional outcome was excellent in five patients, good in ten and fair in three. Bony union was confirmed six months after surgery in 17 patients, but in one patient this was not achieved until two years after operation. The mean lordotic angle before operation was 20 degrees (-2 degrees to 42 degrees ) and the mean lordotic angle at the final follow-up was 32.5 degrees (17 degrees to 44 degrees ). Two patients had a superficial wound infection and two a transient root injury. Posterior lumbar interbody fusion with an autogenous iliac crest bone graft and pedicle screw fixation via a posterior approach can provide satisfactory results in pyogenic spondylodiscitis.