Spontaneous Posterior Iliac Crest Regeneration Enabling Second Bone Graft Harvest; A Case Report

We present a case of a revision spinal fusion in which successful bone graft reharvesting was performed from the posterior iliac crest 4 years after initial intracortical harvesting. To date, only anterior iliac crest regeneration has been reported in orthopedic trauma patients. A 70-year-old man with a history of two prior instrumented lumbar fusion operations developed thoracolumbar kyphosis junctional to the lumbosacral fusion mass. His first operation was an instrumented posterolateral lumbar fusion L1 to L5, where bone graft was harvested from the right iliac crest using the intracortical harvesting technique. The second procedure was performed 18 months later and consisted of an extension of the fusion to the sacrum due to L5–S1 level derived symptoms. The bone graft for this procedure was taken with the same technique from the left iliac crest. The development of thoracolumbar junctional kyphosis necessitated the third operation, which consisted of a same-day anterior–posterior extension of the fusion to T10. Prior to this third procedure, a spinal computer tomography was performed that documented regeneration of the cancellous bone in the right iliac crest. This permitted reharvesting of almost 40 ml of cancellous bone using the intracortical bone harvesting technique from the right iliac crest. Histological analysis showed mature bone. Cancellous bone regeneration and restoration of the local anatomy of the ilium are possible after intracortical bone harvesting. This regeneration can provide autologous bone graft to assist fusion in subsequent operations.     

自体髂骨骺板移植重建胫骨骺板

目的　研究自体髂骨骺板移植修复胫骨骺板损伤的效果。方法　 6周龄新西兰白兔 10只 ,切取全层髂骨骺板软骨 ,切除双侧胫骨上端骺板前内侧部分 1/ 2 ,然后将所取的髂骨骺板软骨移植入左侧骺板损伤处 ,右侧不进行移植作为对照。第 8周时摄双侧下肢X线片 ,并取双侧胫骨上端 ,行HE染色及甲苯胺蓝染色。结果　移植 8周时胫骨角对照组 38 80± 3 5 0 ,髂骨骺板移植组 8 36± 3 9(P <0 0 1)。组织学检查示对照组胫骨近端骺板内侧缺损处有明显骨桥形成 ,移植组骺板缺损区由骺板样软骨修复充填 ,与邻近骺板融合 ,无骨桥形成。结论　自体髂骨骺板移植修复骺板损伤效果良好     

髂后上嵴取骨切口的改进

目的：通过髂后上嵴取骨切口的改进。使术后的并发症减少。可推广应用。方法：以往的髂后上嵴取骨切口为平行髂嵴或髂嵴上的横切口（对照组）。改进的切口为垂直于髂后上嵴脊柱旁开8.0cm的斜切口（改进组）。自1996年2月-1998年10月共施行髂后上嵴取骨98例，其中改进组48例，对照组50例，就其临床效果及随访记录进行分析。结果：改进组中取骨切口并发症如；术后血肿、切口深压痛、皮肤麻木、敏感等明显低于对照组。结论：改进的髂后上嵴取骨切口术后并发症少，取骨量如常，有较大的临床意义。值得推广应用。     

颈椎前路减压术自体髂骨移植的并发症(附451例临床报告)

本文报告４５１例颈前路环锯减压，环锯法髂骨移植的临床结果。其中单节段植骨４２０例，双节段植骨２７例，三节段４例。所有患者均获得骨性融合。仅１０例有轻度成角畸形和椎间隙高度降低，该畸形不影响临床疗效。供区并发症以切口疼痛、切口血肿及局部皮神经损伤为主，其发生率为９．１％，主要并发症为０．７％，次要并发症为８．４％。作者认为，准确选择切口部位和长度，合理止血，皮肤无张力缝合可降低供区并发症。环锯法取骨是一种安全简便的方法，三面皮质骨和两面皮质骨对供区骨融合无明显差异。多节段植骨应考虑同时应用内固定。     

Iliac crest reconstruction with a bioactive ceramic spacer

This study aimed to investigate the long-term clinical results of the apatite wollastonite-containing glass ceramic (AWGC) iliac spacer and to discuss its efficacy in reconstruction of the bone graft donor site at the iliac crest. Thirty-one patients were studied for more than 10 years. All patients underwent anterior spinal fusion using autogenous tricortical iliac bone graft. After harvest of tricortical iliac bone graft, an AWGC iliac spacer ranging from 15 mm to 70 mm in length was press-fitted into the gap. Long-term clinical results were obtained from radiological and blood examinations. Thirty patients (97%) were satisfied with the spacer. There was new bone formation around the spacer on the radiograph. There was no abnormal silicon concentration in blood examinations. AWGC iliac spacer appears to be useful in the reconstruction of harvested iliac crest. New bone formation occurs, reducing the defect size.     

Comparison of a modified minimally invasive with an open technique following harvesting of cancellous iliac bone

The open technique for obtaining cancellous iliac bone is often used for the repair of the cleft defects of the alveolus. However, recently a number of authors have stated that the morbidity and long-term cosmesis are unacceptable. The results of a long-term retrospective study of the donor sites in 47 patients who underwent the open technique are discussed. No major long term morbidity was found but a number of minor, troublesome symptoms were revealed in 36% including, itching, discomfort, hypertrophic scars and anaesthesia. The scar was considered unacceptable with a mean of 60 mm length and 4 mm wide. A minimally invasive technique is described that produces an adequate volume of milled bone, between 1.5 mls and 4 mls, (equivalent to 3–8 mls of unmilled bone). Discomfort was minimal postoperatively, and both gait and scar showed a highly favourable outcome. This unit is no longer employing the open technique for cancellous iliac bone removal.     

Bone Remodeling at the Iliac Crest Can Predict the Changes in Remodeling Dynamics, Microdamage Accumulation, and Mechanical Properties in the Lumbar Vertebrae of Dogs

We previously demonstrated that suppression of bone remodeling allows microdamage to accumulate, thereby leading to reduced bone toughness in dog bone. In this study we evaluated the relationships between bone remodeling at the iliac crest and skeletal activation frequency, microdamage accumulation, or biomechanical properties of lumbar vertebrae using the same dogs to determine whether bone remodeling at the iliac crest can predict damage accumulation and mechanical parameters of the lumbar spine following treatment with antiresorptive agents. Thirty-six female beagles, 1 to 2 years old, were divided into three groups. The control group was treated daily for 12 months with saline vehicle. The remaining two groups were treated daily with oral risedronate at a dose of 0.5 mg/kg/day, or alendronate at 1.0 mg/kg/day orally. The doses of these bisphosphonates were 5 to 6 times the clinical doses approved for treatment of osteoporosis in humans. After sacrifice, the right ilium and L2 vertebra were assigned to histomorphometry. The left ilium and L3 vertebra were used for microdamage analysis. The L4 vertebra was mechanically tested to failure in compression, and bone toughness calculated from the stress–strain curve. There was a strong positive relationship for activation frequency (Ac.f) between ilium and lumbar vertebrae (r² = 0.82; P < 0.0001). Iliac crest Ac.f underestimates Ac.f in L2, but L2 Ac.f reaches a minimum threshold and does not decline further when iliac crest Ac.f is below 0.10/yr. Microdamage (Cr.S.Dn) accumulation at the ilium was significantly associated with increased microdamage accumulation in the L3 lumbar vertebra (r² = 0.43, P < 0.0001). The data also show that bisphosphonate treatment increased Cr.S.Dn at a faster rate in L3 than in the iliac crest. Although bisphosphonate treatment decreased bone toughness in L4, this decrease demonstrated no relationship to decreased Ac.f in the ilium. These results clearly indicate that bone remodeling data obtained from iliac crest biopsy could be used to estimate the activation frequency and microdamage burden in the vertebral column.     

髂骨块植骨结合内固定治疗跟骨严重骨折

目的评价髂骨块植骨结合内固定治疗跟骨严重骨折的疗效。方法2000年5月～2007年4月收治54例57足跟骨骨折,行髂骨块植骨结合内固定治疗,对患者术后骨折复位、并发症进行随访。结果平均随访时间为50.4个月,术后Gissane角及Bohler角均恢复,骨折全部骨性愈合。按Maryland评定标准,优39足,良14足,可3足,差1足,优良率为92.98%。结论选择髂骨块植骨治疗跟骨骨折能达到解剖复位或近似解剖复位,直接恢复跟骨的Gissane角及Bohler角,可减少外固定时间,降低术后并发症的发生率。     

Postoperative pain following posterior iliac crest bone graft harvesting in spine surgery: a prospective,randomized trial

Background Context

Postoperative pain at the site of bone graft harvest for posterior spine fusion is reported to occur in 6%–39% of cases. However, the area around the posterior, superior iliac spine is a frequent site of referred pain for many structures. Therefore, many postoperative spine patients may have pain in the vicinity of the posterior iliac crest that may not in fact be caused by bone graft harvesting. The literature may then overestimate the true incidence of postoperative iliac crest pain.

Morbidity of iliac crest donor site in cleft lip and palate infants

The purpose of this study was to evaluate long-term morbidity associated with iliac crest bone harvesting at the age of 3–6 months. This bone was taken for early bony reconstruction in alveolar clefts. In 40 patients with an average follow-up of 6 years, no problems were noted by the parents. In 11 patients randomly subjected to clinical examination, muscle testing, joint mobility measurements, and gait analysis, there were no complications or abnormalities of any kind. Received: 3 February 2000 / Accepted: 11 May 2000