脊柱手术髂骨取骨并发症探讨

目的探讨脊柱融合术后髂骨取骨并发症情况及其对患者身体健康和日常生活的影响。方法回顾性调查2003年1月至2008年12月因脊柱融合手术行髂骨取骨的56例患者。采用Skaggs问卷及Schwartz提供的髂骨取骨并发症问卷对患者髂骨区并发症进行综合分析。简明健康测量量表（SF-36）对患者术后半年时的躯体健康状况进行评估。同时应用脊柱功能障碍指数（ODI或NDI）量表对患者脊柱术后半年日常生活情况进行评价。采用两独立样本的t检验和秩和检验分析取骨区疼痛与患者脊柱术后躯体健康和日常生活的关系。结果56例患者均随访术后半年时的情况，有12例f21．4％）术后半年内出现不同程度的并发症，其中7例（12．5％）轻度并发症，5例（8．9％）为中度并发症，未出现重度并发症患者。11例（19．6％）患者出现髂骨取骨区的疼痛，视觉疼痛评分（VAS）为2．7分（1～6分）。有3例（5．4％）患者髂骨取骨区有麻木感。1例（1．8％）患者取骨区切口瘢痕不满意。没有发生切口感染、骨盆骨折等其他并发症。取骨区疼痛作为最常见的并发症与脊柱术后躯体健康评分和脊柱功能障碍指数之间差异有统计学意义（P〈0．05）。而其与患者年龄、性别及取骨部位未见有统计学差异。结论髂骨取骨术后并发症有较高的发生率，取骨区疼痛是其中最常见的并发症，对患者脊柱术后躯体健康和日常生活有影响，需要引起重视。

The investigation into the complications after iliac crest bone graft in spinal surgery

Objective To investigate the complications after iliac crest bone graft in spinal fusion surgery, and further to evaluate the influence of such complications on patients＇ physical health and daily life. Methods A total of 56 patients who underwent spinal fusion surgery with iliac crest bone graft from January 2003 to December 2008 were investigated retrospectively. The complications after iliac crest bone graft were analyzed comprehensively with the questionnaires provided by Skaggs and Schwartz. The patients＇ physical health half a year after surgery was evaluated by the Short-Form-36 （SF-36） health survey. And meanwhile, the Oswestry Disability Index （ODI） or Neck Disability Index （NDI） scores were used to evaluate the functional limitations in everyday life because of spinal fusion surgery. Independent-samples t test and rank sum test were used to analyze the relationship between the pain in bone graft site and the patients＇ physical health and daily life after spinal surgery. Results All 56 patients were followed up half a year after surgery. Complications in various degrees were found in 12 of 56 patients （21.4%）, among whom there were 7 patients with slight complications （12.5%）, 5 patients with moderate complications （8.9%）, and no patients with major complications. 11 patients had pain in bone graft site （19.6%）, and the visual analogue scale （VAS） scores, on a scale of 1 to 10, ranged from 1 to 6, with a mean of 2.7 points. 3 patients were bothered by harvest site numbness （5.4%）, and 1 patient was not satisfied with the appearance of scars （1.8%）. No complications like incision infection, pelvic fracture and so on occurred. There were statistically significant differences in the outcomes between the most common complications of donor site pain and SF-36 scores, ODI and NDI scores （P〈0.05）. However, there was no statistically significant difference between donor site pain and the age, sex and donor site. Conclusions There is a high incidence of complications after iliac crest bone graft. Donor site pain as the most common complication affects the patients＇ physical health and daily life, which should be paid much attention.