两种取髂骨方法的临床对比分析

目的探讨操作简便、创伤小、并发症少的切取髂骨方法。方法回顾性分析本院2007年6月至2012年2月间,获得随访的取髂骨的134例患者的临床资料,按照不同的取髂骨术式分成环钻取骨组(69例)、传统的骨刀取骨组(65例)。将手术操作时间、术中出血量、术后并发症(包括髂骨骨折、髂骨凹陷、术后创口脂肪液化、疼痛、麻木)等指标作为临床评价。结果两组的平均手术占用时间无显著性差异,但术中出血量、术后各项并发症有明显差异,环钻组术中出血量及术后并发症明显低于骨刀组。结论术中无需大块特殊形状髂骨植骨时,用环钻取骨操作简便、并发症少,较传统骨刀取骨优势明显,值得临床推广使用。     

栅栏取骨在自体植骨术中的应用

目的 探讨栅栏取骨在自体植骨术中的临床疗效。方法 回顾性分析各种手术需取自体髂骨者采用栅栏取骨术30例的情况。结果 30例获得随访3-20个月,平均15个月,手术时间20-25 min,平均22 min;术中出血量40-90 ml,平均50 ml,术后发生髂骨凹陷1例、供骨区麻木4例、感染1例。结论 栅栏取骨通过重建髂骨三皮质取骨区的骨缺损,术后并发症少,值得临床推广应用。     

钻取式柱状自体髂骨植骨术应用及供骨区术后并发症的临床分析

目的:探讨钻取式柱状自体髂骨植骨术的临床疗效及分析该植骨术对供骨区术后并发症的影响。方法 :自2014年3月至2016年10月,回顾性分析自体髂骨植骨患者68例,按照取骨方式不同,分为钻取式取骨(钻取组)和骨刀式取骨(骨刀组),每组34例。钻取组男24例,女10例;年龄23~53(40.06±5.60)岁;骨刀组男26例,女8例;年龄22~54(39.32±6.44)岁;观察并比较两组患者的取骨手术时间、术中供区出血量、术后供区伤口愈合时间及术后供区并发症等,并采用VAS评分对术后不同时期供区进行疼痛评价。结果:68例患者获得随访,时间12~24个月,钻取组平均16.9个月,骨刀组平均17.1个月。两组受区显示骨愈合结构,采用自体髂骨植骨术均见效果良好。两组手术操作时间差异无统计学意义(P0.05);两组术中供区出血量及术后供区伤口愈合时间差异均有统计学意义(P0.05);两组术后并发症(髂骨凹陷、麻木)差异有统计学意义(P0.05)。术后2周VAS评分两组差异无统计学意义(P0.05),术后6个月和1年钻取组VAS评分均比骨刀组低(1.85±0.61 vs 2.97±0.67,P=0.000;1.15±0.56 vs 2.41±0.61,P=0.000)。结论:术中无须大块特殊形状或较多皮质骨髂骨植骨时,用钻取式柱状自体髂骨植骨术操作简便、术后并发症少;能促进受区早期愈合,改善患者生活质量,较传统骨刀取骨优势明显。     

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。     

新型取骨器的临床应用

目的观察"洛阳铲"式新型取骨器的临床应用效果。方法 2006年8月-2009年10月行自体髂骨移植术并获随访112例,其中男71例,女41例;年龄11～71岁,中位年龄42岁。四肢粉碎性骨折45例,骨不连47例,良性骨肿瘤20例。采用新型取骨法(A组)32例、三面皮质取骨法(B组)29例、内板取骨法(C组)15例、外板取骨法(D组)23例、环钻双面皮质取骨法(E组)13例。各组患者术前一般资料比较差异无统计学意义(P>0.05)。比较各组手术切口长度、手术时间、术中出血量及术后4、7、60d和术后1年疼痛视觉模拟评分(VAS),并观察术后周围神经损伤、骨折、血肿、腹疝、髂嵴凹陷、慢性疼痛发生率。结果 A组手术切口长度、手术时间、术中出血量及术后各时间点VAS评分均优于其余各组,比较差异均有统计学意义(P<0.05)。A组与B组比较术后1年慢性疼痛及髂嵴凹陷发生率差异有统计学意义(P<0.01);与C、D、E组比较周围神经损伤、骨折、血肿、腹疝、髂嵴凹陷、慢性疼痛发生率及与B组比较周围神经损伤、骨折、血肿、腹疝发生率,差异无统计学意义(P>0.05)。但A组6项并发症总例数明显少于其余4组,差异有统计学意义(P<0.05)。结论新型取骨法是一种微创的取骨方法,具有切口长度短、手术时间短、出血量少、术后疼痛程度轻、并发症少的特点。     

钛笼与自体髂骨修复骨缺损在胸腰椎结核手术的疗效对比

目的 探讨钛笼与自体髂骨修复骨缺损在胸腰椎结核手术治疗的疗效.方法 纳入2014年12月～2016年12月于本院治疗的47例胸腰椎结核患者,均采用后路一期病灶清除联合植骨融合与椎弓根螺钉系统内固定治疗,将采用钛笼植骨融合的25例患者设为钛笼组,采用自体髂骨融合的22例患者设为髂骨组.比较两组患者手术相关指标、临床疗效及并发症发生情况.结果 钛笼组手术时间、出血量显著低于髂骨组,差异有统计学意义(P<0.05),两组住院时间、植骨融合时间差异无统计学意义(P>0.05);两组术后1周、3个月、末次随访的Cobb角、VAS评分、ESR均显著降低,末次随访钛笼组Cobb角显著低于髂骨组,差异有统计学意义(P<0.05);两组末次随访Frankel分级较术前均显著改善,组间差异无统计学意义(P>0.05);两组术后并发症差异无统计学意义(P>0.05).结论 后路一期病灶清除联合植骨融合与椎弓根螺钉系统内固定手术中,采用钛笼植骨与自体髂骨融合均能取得较为良好的近远期疗效,但钛笼植骨手术耗时以及出血量较少,可减少远期Cobb角丢失.     

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。     

BMP-2混合自体髂骨植骨在寰枢椎脱位后路复位固定融合术中的应用

目的评价BMP-2混合自体髂骨植骨在可复性寰枢椎脱位后路复位固定植骨融合术中的融合效果的。方法回顾性分析自2004-01—2012-01采用BMP-2与自体髂骨混合植骨进行寰枢椎后路复位固定融合术治疗的41例可复性寰枢椎脱位(BMP-2组),并与同期仅采用自体髂骨植骨治疗的65例(自体髂骨组)进行比较。比较2组手术时间、术中出血量、术后引流量、自体髂骨取骨量、并发症发生率,以及术后12个月时VAS评分、JOA评分、颈椎曲度、颈椎活动度。结果 106例获得平均(25.8±1.6)个月随访,术后12个月影像学检查显示均获得满意复位及骨性融合,融合率达100%。2组手术时间、术中出血量、术后引流量,以及术后12个月的VAS评分、JOA评分、颈椎曲度、颈椎活动度比较差异无统计学意义(P0.05);但BMP-2组自体髂骨取骨量明显少于自体髂骨组,差异有统计学意义(P0.05)。2组并发症发生率差异无统计学意义(χ~2=1.459,P=0.083)。结论采用BMP-2混合自体髂骨进行可复性寰枢椎脱位后路钉棒内固定植骨融合术可以减少自体髂骨的切取量,缩短术后疼痛缓解时间,而且并未增加术后并发症的发生率。     

不同自体髂骨取骨法对患者术后的影响

目的 探讨实用、有效、并发症少的自体髂骨切取方法.方法 以术中切取骨量大小,术后供骨区的疼痛、麻木、感染、及外形等作为临床评价指标评价,采用切取髂骨外板、髂骨板全层及开窗切取矩形髂骨块3种不同自体髂骨取骨方法术后对患者的影响.结果 髂骨外板采骨量较小,切取髂骨板全层及开窗切取矩形髂骨块取骨量基本相同;开窗切取矩形髂骨块...     

老年患者颈椎体前路切除钛网修复和髂骨植骨的比较

目的比较老年患者颈椎前路次全切术中采用钛网融合和自体髂骨植骨的临床疗效。方法回顾分析62例老年颈椎疾病患者,颈椎前路次全切术中分别采用钛网植骨融合和取自体髂骨植骨融合各为30和32例,比较两组手术参数和术后并发症。结果钛网组和髂骨组在术中出血量、手术时间在老年患者中有显著性差异（P〈0.05）,而在住院时间上无明显差异（P〉0.05）,术后钛网组21例移位,髂骨组2例供区血肿。结论颈前路钛网植骨可减少术中出血及手术时间;而自体髂骨融合效果较好。     

自体髂骨与组织工程骨植骨的临床应用对比研究

目的　对比观察组织工程骨移植与自体髂骨植骨修复四肢骨缺损的临床疗效。　方法　自 1 999年7月～ 2 0 0 1年 9月 ,随机选择需要植骨的四肢骨骨折 52例 ,分为 A、B两组 ,每组 2 6例 ,采用常规手术切开复位内固定。A组植入自体髂骨 ,B组植入组织工程骨 ,术后骨科常规处理。对比观察手术耗时、出血量、引流量及伤口愈合情况。术后1、2、3、5个月行 X线摄片观察骨愈合情况。　结果　两组性别、年龄及病种无显著差异 ,术后伤口均 期愈合 ,伤口肿胀程度及引流量无显著差异 ,手术时间 A组平均较 B组长 2 5分钟 ,出血量 A组较 B组平均增加 1 50 ml,骨愈合时间两组均在 3～ 7个月内。骨愈合不良 A组 2例 ,B组 1例。　结论　组织工程骨植入修复四肢骨缺损具有自体髂骨移植相同的临床效果 ;在手术时间与出血量方面 ,组织工程骨植入优于自体髂骨移植     

Comparison between the outer table and intracortical methods of obtaining autogenous bone graft from the iliac crest

STUDY DESIGN: A prospective study in two groups of patients selected randomly. OBJECTIVES: To determine whether keeping the outer and inner cortices of the ilium intact, while obtaining bone graft, would result in reduced postoperative bleeding and less postoperative pain. SUMMARY OF BACKGROUND DATA: Donor site complications after harvesting bone from the iliac crest are frequent. They comprise pain and bleeding related to the large bone exposed, injuries to the cluneal nerve, and sacroiliac instability. METHOD: Sixty patients who were admitted for elective fusion of lumbar segments were included in the study. In half of them, the iliac bone graft was taken in the outer Table method (group A), which included the outer cortex and the cancellous bone beneath, and in the remaining 30 patients only the cancellous bone from between the cortices was collected (group B). The amount of bone harvested, and the time taken to obtain it, were measured, as was the blood volume in the drains. At fixed intervals after surgery and up to 2 years thereafter, the patients were asked to grade the severity of pain in their back and at the donor site. RESULTS: Two years after surgery, 22% of the patients in group A and 17% of the patients in group B reported to have significant pain at the donor site. This difference was not found to be statistically significant, nor was the postoperative bleeding. The average amount of bone harvested in group A was 36 grams compared with 25.7 grams in group B, taking 14 minutes and 20.3 minutes, respectively, to harvest it. These differences were found to be statistically significant. CONCLUSIONS: Preserving the iliac cortices, while obtaining bone graft, does not reduce the postoperative bleeding or the severity of pain at the donor site. In the intraosseous method, less bone is harvested and longer duration of surgery is required, compared with that of the outer Table method.     

髂骨移植并发症的相关研究

[目的]探讨髂骨移植的并发症的原因及预防措施.[方法]回顾研究1990年～2005年10月828例髂骨移植患者,对出现的并发症进行统计分析.[结果]浅感染45例;深部感染10例;局部血肿60例;深部血肿4例;神经损伤30例;血管损伤3例,均发生在髂骨后部取骨时,为臀上动脉断裂;髂骨骨折2例,腹壁疝1例.[结论]取骨位置及操作不当是引起并发症的主要原因,了解髂骨解剖特点,正确选择取骨位置、微创操作是预防并发症的主要措施.     

The percutaneous trephine technique for harvesting iliac crest bone graft in alveolar clefts and its effect on donor site morbidity and quality of bone graft

The percutaneous trephine technique uses a bone marrow biopsy needle to harvest cancellous bone graft from the anterior iliac crest. The subjects of this study were 41 patients with 47 alveolar clefts who underwent secondary bone grafting over a period of 5 years, using the above technique. The donor site morbidity was evaluated retrospectively by means of a postal questionnaire and case note survey. Patients were questioned about severity of pain, duration of pain and duration of limping. None of the patients had donor site pain or limping for more than 2 weeks. No patient had severe donor site pain. Case note surveys revealed no donor site complications of haematoma, sensory disturbance, wound breakdown or contour abnormality. In 85.10% (n=40) of the alveolar clefts where the canine tooth had reached its final position at the bone grafted site, dental radiographs were used to assess the interalveolar septal height. In 82.5% (n=33) the interalveolar septal height was more than three quarters of normal i.e. a successful result. In conclusion the percutaneous technique causes minimal donor site pain and gait disturbance. It is a simple and safe technique, easy to learn and quick to perform leaving the patient with an imperceptible donor site scar. The results of clinical and radiological assessment of the quality of the bone graft also compare favourably with the conventional open technique of harvesting iliac crest graft in cases of alveolar clefts. Received: 31 December 1997 / Accepted: 20 July 1998     

腰椎间螺纹异体皮质骨融合支架的研制与临床应用

目的　探讨螺纹异体骨椎间融合支架 (allograftinterbodyfusioncage ,AIFC)腰椎间融合的生物力学特性及临床效果。 方法　用 4具新鲜尸体的尺骨、桡骨和腓骨自行研制成AIFC ,同时用环钻切取带双面皮质的髂骨行压缩试验 ,并模拟临床切除L2～ 3,L4～ 5椎间盘后分别植入髂骨和AIFC ,行拔出试验。将AIFC用于 10例腰椎滑脱和腰椎不稳病人 ,观察其临床效果及手术并发症 ,并做X线征评价。结果　①最大抗压负荷AIFC组为 82 6 8± 490 3N ,髂骨组为 1385± 2 2 3N ,AIFC组为髂骨组的 6倍 (P <0 0 1) ,②最大拔出力AIFC组为 489± 2 0 6N ,髂骨组为 89± 45N ,AIFC组为髂骨组的 5 5倍 (P <0 0 1) ,③手术治疗 10例 ,平均随访 12个月 ,临床效果满意 ,无神经并发症发生。AIFC无移位及骨折。术后 3个月动态摄X线片均获骨性融合。手术椎间隙无高度丢失和畸形。结论　AIFC具有足够的支撑、维持或增加椎间隙高度功能 ,抗滑、稳定性好 ,椎间融合率高 ,其设计独特合理 ,符合腰椎生物力学和临床要求     

Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques

We have studied the occurrence of donor site morbidity, cosmesis and overall satisfaction with graft procedure in 76 patients who had undergone iliac crest bone harvesting for anterior cervical discectomy and fusion (ACDF). Totally 24 patients underwent an open procedure and 52 a minimally invasive trephine harvesting method. Although our study demonstrated substantial donor site pain and its effect on ambulation in both groups, this was of limited duration. Two patients, one in each group, suffered long-term pain that was eventually resolved. Totally 8.3% of patients in the open group suffered minor complications and 11.5% in the trephine group. There were two cases of meralgia parasthetica. There were no major complications in either group. There was no statistically significant difference in morbidity between the open and trephine groups. There was a trend towards significance (P = 0.076) for pain at the donor site, with less pain reported by patients who underwent the trephine procedure for harvesting.     

颈前路减压植骨融合器械的设计及临床应用

目的 设计颈前路减压用相应器械并临床应用。方法 设计新型环锯锯芯、双环锯定位器、后纵韧带切除钩及“U”形骨凿等器械并临床应用56例脊髓型颈椎病,其中13例伴有神经根型颈椎病,7例合并后纵韧带骨化;43例为单间隙病变,11例为双间隙病变,2例三间隙病变。均采用新型环锯锯芯定位引导,双环锯减压,以后纵韧带切除钩切除后纵韧带,并以“U”形骨凿切取髂骨骨块行前路植骨融合、钢板内固定术(AO或Orion)。结果 除1例因髂骨骨凿使用不当致髂骨骨块压缩骨折外,其余55例使用本套器械操作者均手术顺利,无神经并发症,无植骨移位及塌陷。结论 新型环锯锯芯、双环锯定位器、后纵韧带切除钩及“U”形骨凿等器械应用于颈前路减压术具有设计合理、操作简便、使用安全等优点。     

Ambulatory in-office anterior iliac crest bone harvesting.

OBJECTIVE: A prospective study was performed to evaluate the harvesting of autologous bone within the private practice environment, using either a power-driven trephine or corticocancellous block harvesting, and to assess the clinical safety, postoperative morbidity, and patient satisfaction associated with this application. STUDY DESIGN: Thirty-nine patients requiring 40 bone harvests from the anterior iliac crest for maxillofacial reconstruction were included for study. The ages ranged from 16 to 73 years (mean 48.4 years). All surgeries were performed by a single surgeon. Patients were recovered and discharged home directly from the office. RESULTS: Forty iliac crest harvests were performed in the private practice venue from 2001 to 2004, 23 by motorized trephine and 17 by open corticocancellous block harvest. No peri-operative complications were encountered. Postoperative questionnaires were returned by 32 patients. Thirty patients reported that they would undergo hip surgery in an ambulatory environment again if required. CONCLUSION: Harvesting of bone from the anterior iliac crest is a safe and predictable surgical procedure for the private oral and maxillofacial surgical practice setting in selected cases, resulting in a low complication rate. Patient acceptance of this surgery in the private practice venue is high.     

旋髂深血管髂骨骨膜瓣移植治疗股骨颈骨折

目的 回顾分析旋髂深血管髂骨骨膜瓣移植治疗股骨颈骨折的远期疗效。探讨其临床应用价值,并与同期采用人工股骨头置换术及经皮三棱钉固定治疗股骨颈骨折的疗效进行对比研究。方法 切开复位股骨颈开槽,施行旋髂深血管髂骨骨膜瓣移植,三棱钉固定29例,经皮三棱钉固定27例,人工股骨头置换34例。结果 旋髂深血管髂骨骨膜瓣移植治疗组随访3－7年,骨折平均愈合时间3.5个月,1例出现股骨头坏死,其余病例髋关节功能恢复满意;经皮三棱钉固定组随访3－6年,骨折平均愈合时间为7.4个月,6例发生并发症;人工股骨头置换组随访4－7年,9例发生并发症。结论 旋髂深血管髂骨骨膜瓣血管位置恒定,切取容易,疗效可靠,应作为股骨颈骨折治疗的首选,各种方法的经皮穿针内固定虽具有骨折愈合时间长,少数患者可发生骨折不愈合及股骨头坏死的缺点,但由于操作简便,仍为临床常用。而人工股骨头置换目前尚有难以克服的并发症,且疗效随着时间的延长而降低,一旦发生并发症处理非常困难,应严格掌握手术适应证。