The cancellous bone of the iliac crest

A study of the thickness and spacing of bony structures in the cancellous bone of the iliac crest. Ground sections of methacrylate-embedded material from 67 normal subjects, from 20 to 90 years of age, were examined. Increasing age is accompanied by an increase in the spacing between the bony structures, but not by any significant reduction in their thickness. The thinnest bony structures appear to be undergoing the most remodelling, as judged by the extent of formation and resorption surfaces.

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Zusammenfassung Die Dicke der Trabekel und die Weite der Markzwischenräume des Hüftbeinkammes wurden bestimmt. Das in Methacrylat eingebettete Material, welches von 67 Normalpersonen im Alter von 20–90 Jahren stammte, wurde geschnitten und untersucht. Bei zunehmendem Alter vergrößert sich der Raum zwischen den Trabekeln, ohne daß jedoch deren Dicke signifikant vermindert wird. Gemessen am Umfang der Bildungs- und Resorptionsoberfläche scheinen die dünnsten Trabekel dem größten Knochenumbau unterworfen zu sein.

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Résumé Une étude de l'épaisseur et de l'espacement des structures osseuses dans l'os d'aspect réticulé du crête iliaque. Les specimens provenant de 67 sujets normaux, ages de 20 à 90 ans, furent enfoncés dans methacrylate et tranches preparés par meulage. L'age croissant est accompagné d'une augmentation de l'espacement entre les structures osseuses, mais pas d'une reduction signifiante de leur épaisseur. Les structures osseuses les plus minces paraissent subir le plus grand remondellage, jugant par l'importance de surfaces de formation et de résorption.

     

The cancellous bone of the iliac crest

A study of the thickness and spacing of bony structures in the cancellous bone of the iliac crest. Ground sections of methacrylate-embedded material from 67 normal subjects, from 20 to 90 years of age, were examined. Increasing age is accompanied by an increase in the spacing between the bony structures, but not by any significant reduction in their thickness. The thinnest bony structures appear to be undergoing the most remodelling, as judged by the extent of formation and resorption surfaces.     

Fracture and herniation of bowel at bone graft donor site in the iliac crest

Fracture at a bone graft donor site in the iliac crest is an uncommon but documented occurrence. Herniation at this site requires a deep dehiscence of the wound, and is rare. A patient is reported with complete wound dehiscence in association with a fracture at a bone graft donor site in the iliac crest.     

Bupivacaine for postoperative pain relief at the iliac crest bone graft harvest site

An inevitable side effect of iliac crest bone graft harvesting is postoperative pain at the donor site. Bupivacaine hydrochloride is a long-acting local anesthetic that is clinically effective for approximately 8 hours. The present study was undertaken to assess postoperative pain relief with locally injected bupivacaine at the iliac crest bone graft harvest site. Pain relief with locally injected bupivacaine or saline at the iliac bone harvest site using an indwelling catheter was studied in 13 patients in a prospective, double-blind, crossover study. Twelve patients had cervical diskectomy and arthrodesis with autograft and one patient had a triple arthrodesis of the foot. There were no statistically significant differences between patients given bupivacaine and patients given saline with respect to pain relief ratings and hip-pain ratings at rest and motion during the first 24-hour postoperative period and the second 24-hour postoperative period (Mann-Whitney test). The single diabetic patient who had a triple arthrodesis developed a wound infection at the catheter placement site. The number of patients was too small to draw conclusions about the differences in pain-medication requirements between patients undergoing single versus multiple diskectomies and fusions. In view of the lack of improvement in pain relief and the risk of infection, local administration of bupivacaine at the iliac bone harvest site is not recommended in its present form for postoperative analgesia.     

Histomorphometry of fresh frozen iliac crest bone biopsies

Summary Although methods are well established for the rapid histological preparation of fresh frozen soft tissues, they remain inadequate for the preservation of hard tissues. A recent technique for sectioning fresh frozen bone, in which sections can be prepared within an hour, has been applied to undecalcified human iliac crest bone biopsies. Quantitative analysis has shown that the static remodeling variables deduced from frozen sections closely resemble those derived from plastic-embedded sections prepared for routine use by established laboratory procedures. It is concluded that the rapid method is reliable for immediate diagnostic and histomorphometric purposes.     

Cancellous bone in the anterior part of the iliac crest

Summary Calcified tissue in the iliac crest and the adjoining ala of the ilium was investigated by scanning electron micrographs of thick, polished sections from which the marrow had been removed. Some quantitative properties of the trabeculae and of the marrow spaces were obtained from measurements on the images of the polished surfaces. Most of the cortex of the crest was porous, about 25% void, of varying thickness, intruding into the cancellous space in some regions. A structure containing about 35% by volume of bone was found at and near the anterior superior spine. Compact bone of normal appearance began as thin medial and proximal sheets below the crest, and thickened until at 20–30 mm it was substantial. The cancellous bone contained by these structures was varied. Two main zones were distinguished, whose junction ran from just below the anterior superior spine to the lower portion of the iliac fossa. In the lateral zone, adjacent to the crest, there were arch-like structures, commencing from the medial and proximal walls, and meeting, or even crossing, near the centre. The medial zone was distinguished by large marrow cavities and strongly orientated trabeculae. The relative volume of bone was similar in the two zones, falling from a maximum of 15–20% to about 5% in the regions of the anterior inferior spine and the iliac fossa. The average width of the trabeculae was significantly greater in the medial than in the lateral zone (W _b (m)0.16 mm, W_b(l)0.12 mm). Inclusions of very heavily constructed trabeculae, having average widths of about 0.35 mm, were found in both zones.     

Donor site morbidity in the iliac crest bone graft.

BACKGROUND: Open iliac crest bone grafting is a common surgical procedure with recognized short-term complications. The present paper documents the medium- to long-term complications and level of patient satisfaction following the procedure. METHODS: Seventy-three patients undergoing an open iliac crest bone graft over the past 6 years at Wellington Hospital were retrospectively reviewed. All patients completed a postal questionnaire which assessed their current pain, sensory changes in and below the scar, scar appearance and overall appearance with the bone graft donor site. RESULTS: Sixteen patients (21.9%) reported pain, 11 patients (15%) stated that their scar was sensitive to touch and 19 patients (22%) reported a degree of sensory change below the scar. Six patients (8.2%) felt that the scar appearance was totally unacceptable. Overall satisfaction, however, was high with 70 patients (95.8%) 'fairly satisfied' or 'totally satisfied' with their iliac crest donor site. CONCLUSIONS: Bone grafting from the iliac crest is a relatively benign procedure in terms of patient satisfaction, and the most significant morbidity is pain.     

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.     

脊柱前路手术髂前嵴取骨并发症相关分析

目的:探讨脊柱前路手术髂前嵴取骨的并发症发生情况。方法:回顾性分析2001年1月-2005年9月取髂骨行脊柱植骨融合术的154例患者,取骨部位均为髂前嵴,统计供骨区并发症,分析其相关因素。结果:术后随访时间均超过1年。28例(18.2%)患者发生不同程度的并发症,其中14例(9.1%)出现轻度并发症,12例(7.8%)出现中度并发症,2例(1.3%)出现重度并发症。127例(82.5%)患者接受了问卷调查,其中17例(13.4%)患者诉取骨处疼痛,疼痛自我感觉评分为1-6分(平均2分),其中3例(2.4%)患者需服用非甾体类抗炎药以减轻疼痛;7例(5.5%)患者诉取骨处有麻木感;无患者诉取骨处的疼痛及麻木感影响其日常活动;122例(96.1%)患者对供骨区切口外观满意。结论:髂前嵴取骨并发症中供骨区疼痛及麻木发生率较高,尤其是疼痛,应引起足够的重视。     

髂骨取骨术后并发症及对策

髂骨取骨术是一常见手术,其术后并发症也不少见,但并未引起广大临床骨科医师的重视。我们随访到1996年5月至2006年7月因各种原因行髂骨取骨术的患者607例,对其引起并发症的原因与机制进行了回顾性分析,并提出相关对策。     

Nondestructive determination of iliac crest cancellous bone strength by pQCT

The close relationship between apparent bone density and compressive strength is well established. In clinical situations, histomorphometry, and determination of the compressive strength on bone biopsies are destructive methods and require two separate biopsies from each patient. The aim of this study was to evaluate whether volumetric bone density measured by peripheral quantitative computed tomography (pQCT) could be used as a nondestructive method for estimating trabecular bone strength of iliac crest bone biopsies, thereby allowing the same biopsy to be used for subsequent histomorphometry. Materials consisted of trabecular bone samples prepared from unilateral transiliac crest bone samples obtained at autopsy [total 95 specimens; 41 females (21–90 years) and 54 males (23–87 years)]. From these, the apparent density of the cancellous bone was evaluated by pQCT in a 1-mm-thick slice in the middle of the biopsy and also by ash density measurement. Bone strength was measured by compression test. A strong power relationship was found between density measured by pQCT and compressive strength (r = 0.93, p < 0.00001). Likewise, there was a strong power relationship between ash density and compressive strength (r = 0.97, p < 0.00001). A linear correlation was found between pQCT measurement and ash density (r = 0.98, p < 0.00001), indicating a very high accuracy for the pQCT measurement. In conclusion, pQCT provides a very good estimate of cancellous bone strength. This nondestructive assessment of strength of iliac crest bone biopsies thereby enables biomechanical information as well as histomorphometric measurements to be obtained from the same biopsy.     

Anterior iliac crest bone graft harvesting using the corticocancellous reamer system

OBJECTIVE: To evaluate the anterior iliac crest bone graft harvesting procedure using a corticocancellous acetabular reamer system. DESIGN: A total of 390 bone grafting procedures were reviewed using retrospective chart review. Two hundred twenty procedures were performed using the reamer system, and 170 were performed using traditional techniques (cortical strip, tricortical wedge, and cancellous trap door grafts). SETTING: The Hospital for Special Surgery, New York, New York. PARTICIPANTS: Operative cases involving an anterior iliac crest bone graft procedure between January 1, 1991 and February 28, 1998. MAIN OUTCOME MEASUREMENTS: Complications were organized by the categories major, intermediate, and minor. Statistical analysis included assessment of comorbidity to determine risk factors that may be associated with a propensity for complications. RESULTS: Of the 390 patients reviewed, 13.1 percent (51 of 390) developed a total of seventy-one complications. Of the seventy-one complications, forty were reamer-associated and thirty-one were traditional method-associated complications. As compared with the traditional group, major morbidity was lower in the reamer group (0.9 percent [2 of 220] as compared with 1.8 percent [3 of 170] [ p = 0.4]). Intermediate and minor morbidity were slightly higher in the reamer group than in the traditional group (5.9 percent [13 of 220] as compared with 5.3 percent [9 of 170] [ p = 0.7] and 9.5 percent [21 of 220] as compared with 7.1 percent [12 of 170] [ p = 0.4], respectively). Of the forty reamer-associated complications, 90 percent (36 of 40) resolved within ninety days (average 36.6 days). Of the thirty-one traditional method-associated complications, 74.2 percent (23 of 31) were resolved by 90 days (average 50.6 days). Using logistical regression analysis obesity (body mass index) ( p = 0.03) and smoking ( p = 0.03) were correlated with development of a complication. Furthermore, if a patient was obese and a smoker, the analysis predicted an 83 percent chance of developing a complication. CONCLUSIONS: The reamer technique was found to be safe and efficacious while producing a large amount of autogenous corticocancellous bone graft. Overall complication rates for the reamer and the traditional groups were comparable. The corticocancellous reamer system represents an effective option for bone graft harvesting.     

颈前路减压自体髂骨植骨术供区晚期并发症的临床观察

目的:观察颈前路减压自体髂骨植骨术供区的晚期并发症并分析相关因素.方法:16例颈椎伤病患者行颈前路减压自体髂骨植骨术.髂前上棘后2～3cm处沿髂嵴向后作切口,取全层髂骨.切口置半管引流,加压包扎2～3d,24～48h拔除引流管.术后24h可在颈托保护下坐起或下地活动.结果:全部病例随访6～84个月,平均15.4个月.供区严重并发症3例,占18.8%.结论:颈前路减压自体髂骨植骨术供区并发症将对患者工作生活造成明显影响,不容忽视.临床上应重视取骨手术技巧及颈椎伤病新术式新材料的应用以减少或杜绝供区并发症的发生.     

The concentration of calcium and phosphorus in trabecular bone from the iliac crest

Summary The concentrations of calcium and phosphorus were determined in central parts of bone trabeculae in the human iliac crest by means of an energy dispersive microanalysis technique. Two age groups, each consisting of six suddenly diseased male subjects, were investigated. It was found that the concentrations of calcium and phosphorus did not differ between young and old men. The obtained mean values were fairly alike and determined to 40 and 17 weight %, respectively.