PMMA骨水泥与骨蜡治疗髂后取骨区骨缺损创面的对比研究

目的 比较使用聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)填充与骨蜡涂抹髂后取骨区骨缺损处创面的临床效果.方法 回顾性分析本院2010年1月至2015年1月经髂后入路行自体髂骨取骨的82例患者临床资料,分为PMMA组(43例)与骨蜡组(39例).比较两组手术时间、取骨量、术中出血量、术后24 h引流量、术后至拔管总引流量、术后拔管时间,以及术后1、2周和2、12个月疼痛视觉模拟评分(visual analogue score,VAS);观察术后伤口裂开、局部血肿、感染、周围神经损伤、取骨区长期疼痛(≥6个月)、髂骨骨折、腹疝、取骨区凹陷等并发症发生率;评价术后1年患者对取骨区外观满意度及系腰带时舒适度.结果 两组手术时间、取骨量比较差异无统计学意义(P＞0.05);两组术中出血量、术后24h引流量、术后至拔管总引流量、术后拔管时间及各时间点VAS评分比较差异均有统计学意义(P＜0.05),PMMA组均优于骨蜡组;PMMA组术后1年取骨区外观满意率及系腰带时舒适率均优于骨蜡组;PMMA组术后并发症总数明显少于骨蜡组(P＜0.05).结论 使用PMMA填充重建髂后取骨区骨缺损具有操作简便、能较好地保持髂部外形完整、出血量较少、术后疼痛程度轻及并发症少的特点.

Comparison of PMMA bone cement and bone wax in treatment of iliac bone defects at the bone graft donor site

Objective To compare the effects of polymethyl methacrylate (PMMA) bone cement filling versus application of bone wax in the treatment of iliac bone defect at the bone graft donor site.Methods Clinical data were collected from 82 patients undergoing autogenous iliac bone graft harvesting through a posterior approach in our hospital from January 2010 to January 2015.Mter graft harvesting,the bone defects at the donor site were repaired by PMMA bone cement filling in 43 patients (PMMA group) and by application of bone wax in 39 patients (bone wax group).The operation time,bone graft mass,intraoperative blood loss,volume of drainage within 24h postoperatively and from the end of the operation to extubation,postoperative extubation time,and the pain visual analogue scale (VAS) at 1 and 2 weeks and 2 and 12 months after the operation were recorded.The incidences of complications including infection,wound dehiscence,local hematoma,nerve injury,chronic pain at the donor site (for over 6 months),iliac fracture,abdominal hernia,and depression at the donor site were observed.At 1 year after the operation,the patient's satisfaction with the appearance of the donor site and discomfort with the belt were evaluated.Results No significant differences were found between the 2 groups in the operation time and bone graft mass (P ＞ 0.05).Compared with those in bone wax group,the patients in PMMA group had less intraoperative blood loss and volume of drainage within 24 h postoperatively and till extubation,shorter postoperative extubation time,and lower VAS scores at each of the time points(P ＜0.05).The patients in PMMA group also had higher levels of satisfaction with the appearance at the donor site,reported less discomfort when fastening belt,and had a lower incidence of postoperative complications than those in bone wax group (P ＜0.05).Conclusion Compared with management with bone wax,PMMA bone cement filling for repairing the bone defect at the donor site of autogenous iliac bone graft is more convenient,better preserves the integrity of the ilium,and causes milder postoperative pain and less complications.