髂骨块移植治疗髋臼后壁缺损的远期疗效分析

目的探讨髋臼后壁粉碎骨折进行髂骨移植再造的可行性及远期疗效观察。方法1994年6月～2000年6月间应用髂骨移植再造后壁治疗髋臼后壁粉碎性骨折合并骨缺损13例,随访总结疗效及经验。结果所有患者经5～10年(平均8．5年)的随访,远期髋关节功能和异位骨化分别按d'Aubigne 6分法和Brooker标准评估。髋关节功能优8例,良3例,可2例,优良率为84．6%。其中异位骨化BrookerⅡ°1例。5年后并发创伤性关节炎2例,经保守治疗症状缓解,无切口感染、髋关节再脱位发生。结论髂骨块后壁再造是治疗髋臼后壁粉碎性骨折伴缺损的简单、安全、有效术式。如后期并发严重的创伤性关节炎,再造后壁也能为日后全髋关节置换创造良好的骨性基础。     

带血管蒂髂骨移植修复髋臼陈旧性骨折和缺损

目的 探讨带血管蒂髂骨移植复髋臼陈旧性骨折和缺损的治疗方法。方法 将骨折的髋臼复位，保留较大的臼顶缘骨块，去除其他游离骨碎片，切取带旋股外侧动静脉升支为血管蒂的骼骨块固定骨折并修复臼顶和后壁的缺损。术后下肢骨牵引3周，关节和肌肉训练3周，而后扶拐行走锻炼。结果 本组9例，随访2－4年，优4例，良5例，3个月后均弃拐行走，髋臼愈合良好，无股骨头再脱位发生。1例轻度跛行，2例长距离行走时髋关节轻度疼痛。结论 以珲旋股外侧动静脉为血管蒂的髂骨块修复髋臼陈旧性骨折和缺损的方法容易操作、效果良好。     

钛网结合重建钢板内固定治疗髋臼后壁粉碎性骨折

目的探讨钛网结合重建钢板内固定治疗髋臼后壁粉碎性骨折的临床疗效。方法采用钛网结合重建钢板内固定治疗18例髋臼后壁粉碎性骨折。结果 18例均获随访6～24个月,平均12个月。骨折复位质量根据Matta影像学评定标准评估:优14例,良3例,差1例。髋关节功能根据改良d’Aubigne-Postel标准进行评定:优14例,良2例,差2例。结论该术式可有效复位、固定每一块碎骨片,恢复髋臼关节面的平整,降低并发症发生率。     

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     

自体髂骨板移植修复距骨滑车缺损

随着交通和建筑业的发展，创伤日趋增多，且严重复杂。自1995～2002年，对12例创伤性距骨滑车缺损，行自体髂骨板移植修复，效果满意。报告如下，     

自体股骨头重建髋臼治疗髋关节发育不良的中期疗效

 目的 总结采用自体股骨头结构性植骨治疗髋关节发育不良继发关节炎的中期疗效及并发症。方法 回顾性分析2001年10月至2011年12月采用自体股骨头重建髋臼方法治疗36例髋关节发育不良患者资料,其中34例获得30个月以上的临床及影像学完整随访资料,男6例,女28例;年龄28~68岁,平均51岁;均为单侧手术,左侧16例,右侧18例。Crowe分型,Ⅱ型12例,Ⅲ型16例,Ⅳ型6例;所用假体除1例为混合型外,其余均为非骨水泥型。临床随访包括术前、术后Harris评分及各种并发症;影像学评估包括双侧髋关节正位（或骨盆正位）、患侧髋关节侧位X线片,以判断人工假体位置、植骨愈合情况。结果 34例患者均获得随访,随访时间31~153个月,平均64.1个月。术前Harris评分为23~56分,平均35.4分;末次随访时为82~95分,平均89分,其中优28例,良6例,优良率为100%。术后2~8个月,10例出现植骨块吸收。术后4例患者发生髋关节假体脱位,遂均采用闭合复位,其中1例于复位后2个月再次发生脱位,再次采用闭合复位后未再发生脱位;另3例均未再发生脱位。1例患者于术后3个月摔倒后出现假体周围骨折,行骨折切开复位钢板内固定术,1年随访时骨折已愈合,至末次随访时假体及内固定位置良好、骨折愈合良好,患髋功能良好。术后1年,1例患者因高血压颅内出血行保守治疗后关节置换侧偏瘫,关节失用。结论 自体股骨头重建髋臼治疗髋关节发育不良整体疗效满意,骨吸收是结构性植骨的一个自然过程,关节脱位是髋关节发育不良全髋置换术后的最常见并发症。     

自体髂骨重建胫骨平台在胫骨外侧平台粉碎性骨折中的应用

目的：采用自体髂骨移植修复重建胫骨平台骨折中骨软骨面的大量缺损，并评价其术后临床结果。方法：对胫骨外侧平台粉碎性骨折中因骨软骨严重碎裂、塌陷而无法复位固定所造成的胫骨平台缺损，用自体髂骨移植的方法予以修复重建。结果：术后经过12个月～5年的随访，平均24个月，按膝关节功能评定标准评分为75～100分，平均85.2分。结论：移植物为髂骨，其供区创伤小，无明显的并发症；受区植入方便，容易固定。可以用来重建胫骨平台。     

自体髂骨重建冠状突治疗尺骨冠状突粉碎性骨折

尺骨冠状突骨折比较少见,Ⅱ型和Ⅲ型骨折在伸肘>30°时常出现肘关节后脱位,肘关节极不稳定,常需手术治疗。部分尺骨冠状突粉碎性骨折骨块细小,手术固定非常困难,笔者于2006年1月~2012年1月取自体髂骨(髂前上棘处取三面皮质骨块)移植重建冠状突治疗6例,临床效果良好。1临床资料     

重建钢板内固定治疗髋关节后脱位伴髋臼后壁骨折

目的探讨重建钢板内固定治疗髋关节后脱位伴髋臼后壁骨折的临床疗效及影响预后的相关因素。方法对35例髋关节后脱位伴髋臼后壁骨折的患者采用K-L入路、AO重建钢板内固定治疗。结果 35例均获随访,时间2年～5年4个月。采用改良Merle d’Aubingne-Postel评分系统评价:优16例,良12例,一般4例,差3例。Matta影像学分级:优13例,好16例,一般5例,差1例。临床结果与X线分级呈显著正相关。患者年龄≥55岁、复位时间≥12 h及复杂性骨折患者中临床评分明显降低。结论对于髋关节后脱位伴髋臼后壁骨折,及时确诊和满意复位、恢复髋臼的连续性和稳定性是取得满意手术疗效的关键;患者年龄、复位时间、骨折类型是影响患者预后的重要因素。     

Use of tricortical iliac crest strut autograft in comminuted posterior wall acetabular fractures: A case series

Purpose

The results for fixation of comminuted posterior wall acetabular fractures are not very promising with reported complications in terms of osteoarthritis, nonunion and malunion which subsequently require conversion to total hip arthroplasty. The conversion to total hip arthroplasty is possible in patients over 50 years of age but not in younger patients. So this requires new methods for salvage of the native hip in young patients.

Free iliac crest grafts with periosteum for treatment of old acetabular defects

Objective: To inquire into the therapeutic effectiveness of free iliac crest grafts with periosteum on old acetabular defects. Methods:From February 1996 to June 2005, 9 patients were treated with free iliac crest grafts with periosteum to reconstruct old acetabular defects. There were 7 males and 2 females and the average age was 41.3 years. The acetabular defects were caused by traffic accidents in 6 cases and fall injury in 3 cases. The time from injury to treatment was 4-13 months and averaged 8 months. Intraoperatively we firstly removed the acetabular fracture fragments of the posterior wall. The femoral head was then reducted. Bone graft was harvested from the iliac crest with periosteum,which was sculpted with a rongeur to conform to the defect. The concave (iliac fossa) side of the graft was placed toward the femoral head. The graft was securedly fixed by two to three leg screws. Results:Postoperative syndrome was not found in any of the cases. Harris' score system showed that the score raised from 32. 3 points preoperatively to 81 points postoperatively. The hip function was evaluated as excellent in 3 cases,good in 4 cases and fair in 2 cases. Conclusions: Although this procedure could not exactly reproduce the anatomy of the hip joint, it enables to restore the posterior stability, provide bone-stock for the hip joints and prevent dislocation of the femoral head.     

The use of a structural free iliac crest autograft for the treatment of acetabular fractures

Introduction

Bone and cartilage deficits in the posterior acetabular wall are severe complications resulting from the unsuccessful management or delayed treatment of acetabular fracture. This potentially disastrous condition cannot be treated reliably with the use of reconstruction plates and screws alone. Therefore, this technical report describes a modified anatomical reconstruction method that uses a structural iliac crest autograft and an acetabular tridimensional memory alloy fixation system (ATMFS) to treat late-stage deficits in the posterior wall of the acetabulum. This paper also describes a clinical study of 22 patients with an average of 6.3 years follow-up to evaluate the clinical outcomes of this method.

Methods

Twenty-two patients, who had an acetabular reconstruction between January 2000 and December 2011 that used a structured free iliac crest autograft to treat late-stage bone and cartilage deficits in the posterior acetabular wall were followed annually with clinical and radiographic evaluations. The average age of the patients was 36.4 years at the time of the procedure, and the average time of follow-up was 6.3 years.

Results

None of the patients in this study lost reduction after surgery, and there were no cases of implant failure. Radiographic analysis using Matta’s X-ray evaluation criteria were excellent in eleven cases, good in eight, and fair on three. The Merle D’Aubigné and Postel clinical outcomes at the final follow-up were as follows: seven cases were excellent, ten cases were good, three cases were fair and two cases were poor.

Conclusions

The use of a modified iliac crest grafting and ATMFS fixation, as a biological method to reconstruct the acetabulum anatomically may offer better congruence of the joint surface and may ensure good hip joint stability during early postoperative exercise. The medium to long-term results of this method are encouraging.     

Hernia through iliac crest defects

Summary Herniation of abdominal contents through the donor site in the ilium occurred in 5% of a series of 59 bone grafts. Four patients had this condition at a 7 year follow up, and 2 were repaired with synthetic mesh. Age, gender, obesity and surgical technique are important causative factors. Preventive measures are proposed which have been successful during the past 3 years.

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Résumé La hernie du contenu abdominal à travers l'ilion après prise de greffe osseuse est une complication peu fréquente, mais dans notre expérience, l'incidence est élevée avec 5% sur une série de 59 greffes iliaques. Quatre patients sur une période de 7 ans, ont présenté cette complication. Deux d'entre-eux ont été opérés suivant la technique de reconstruction utilisant un filet synthétique. Des facteurs physiopathologiques ont été étudiés et les plus importants sont, d'après nos résultats, l'âge, le sexe, l'obésité et la technique chirurgicale. Pour éliminer cette complication, nous proposons plusieurs mesures prophylactiques que nous avons employées avec succès au cours des 3 dernières années.

     

Incisional hernia through iliac crest defects

Summary Although the iliac crest ist the most common site from which autogenous bone grafts are obtained, complications are surprisingly rare. One of these is incisional hernia through the resulting bony defect. Occasionally, the herniated contents may proceed to obstruction or strangulation and require emergency surgery. Elective repair of such hernias is advisable in order to avoid such complications. Attention to primary closure of bony iliac defects when complete is mandatory to prevent the occurrence of incisional hernia.     

Proplast reconstruction of iliac crest defects

Proplast reconstruction of iliac crest defects resulting from bone grafts taken for anterior lumbar and cervical fusions is described. The procedure improves the cosmetic result, prevents postoperative muscle herniation and may decrease postoperative donor site pain. It is a simple procedure with low complication rate when performed in the manner described.     

Posterior wall reconstruction using iliac crest strut graft in severely comminuted posterior acetabular wall fracture

Osteosynthesis of comminuted posterior acetabular wall fractures is a challenging task for surgeons. We report a series of eight cases of such fractures where the comminuted fragments were excised and the defect in the posterior acetabular wall was reconstructed with iliac crest strut graft. The graft was buttressed with a reconstruction plate on its posterior aspect. The patients were followed up every week until radiological signs of union were seen. Subsequent follow-up was after six months, one year and annually. Patients were evaluated clinically by Merle d’Aubigne and Postel score and radiologically by Matta score at their final follow-up. All fractures united radiologically after an average follow-up of 3.2 months. The clinical outcome after mean follow-up of 3.34 years (minimum two years and maximum five years) was as follows: two (25%) were excellent, two (25%) were very good, three (37.5%) were good and one (12.5%) was fair. Radiological grading at last follow-up showed excellent in one (12.5%), good in four (50%) and fair in three (37.5%) patients. No complication in the form of infection, heterotopic ossification, neurovascular injury or graft resorption was noticed. To conclude, excision of the small comminuted fragments and reconstruction of the wall using iliac crest strut graft is a viable alternative technique for reconstruction of the comminuted posterior acetabular wall fracture. The medium-term clinical and radiological results of this technique are satisfactory.     

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.     

Chronic finger joint instability reconstructed with bone-ligament-bone graft from the iliac crest

Five patients with chronic instability of digital joints presented with instability and functional disability. Two patients had ulnar collateral ligament damage of the thumb metacarpophalangeal joint and another had chronic multidirectional instability due to radial collateral ligament, dorsal capsule and palmar plate laxity of the metacarpophalangeal joint of the thumb. The fourth patient had a lax radial collateral ligament and palmar plate of the proximal interphalangeal joint of the little finger and the fifth had chronic laxity of the ulnar collateral ligament of the interphalangeal joint of the thumb. All were reconstructed with bone-ligament-bone graft harvested from the iliac crest. The graft was fixed with screws and joint stability was achieved intra-operatively in all patients. All patients achieved a stable joint with improved functional performance at final follow-up.