保留髂嵴的髂骨翼取骨术  

An iliac-crest-preserving iliac wing bone graft harvesting technique

作　　者：蔡鸿敏 倘艳锋 李红军 刘又文 李无阴 侯志勇[2] Cai Hongmin;Tang Yanfeng;Li Hongjun;Liu Youwen;Li Wuyin;Hou Zhiyong(Hip Center of Luoyang Orthopaedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopaedic Hospital), Luoyang 471002,China;Trauma emergency center,the Third Hospital of Hebei University,Shijiazhuang 050000,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)髋部疾病研究与诊疗中心,471002 [2]河北医科大学第三医院创伤急救中心,石家庄050000

出　　处：《中华骨科杂志》2019年第10期589-595,共7页Chinese Journal of Orthopaedics

基　　金：河南省科技攻关项目(162102310370).

摘　　要：目的探讨一种保留髂嵴的髂骨翼取骨技术的临床应用效果以及取骨区骨再生情况。方法收集2016年1月至2017年6月通过保留髂嵴的髂骨翼取骨术取自体髂骨进行骨移植治疗的39例患者资料,其中男28例,女11例;年龄16~59岁,平均(35±13)岁;单侧取骨38例,双侧取骨1例;股骨骨折不愈合15例,胫骨骨折不愈合8例,股骨头坏死(保髋治疗)11例,髋关节结核遗留骨性关节炎并骨缺损(全髋关节置换)1例,髋关节假体松动翻修2例,股骨近端良性骨肿瘤2例。所有患者治疗方案均为包括自体髂骨移植在内的综合手术。记录取骨手术时间、出血量、取骨量及术后取骨区视觉模拟评分(visual analogue scale,VAS),观察并发症,评估取骨区骨再生情况。结果本组39例(40侧)取髂骨手术时间为19~36 min,平均为(25±4) min;出血量为60~150 ml,平均(79±23) ml;髂骨取骨量16~35 cm^3,平均(27±6) cm3。术后24 h患者VAS评分为1~3分,平均(1.8±0.7)分;术后6周及之后复查,患者VAS评分均为0分。本组中38例(39侧)取髂骨切口均一期愈合,1例切口于术后第6天因血清肿而出现切口排液,经非手术处理后延期愈合,所有切口均无感染。所有患者均无股外侧皮神经损伤。2例术中在以髂嵴为支点翘起骨块过程中出现髂嵴裂纹骨折,因无移位而未特殊处理且均于术后3月复查拍片时愈合;随后将翘起骨块的支点转移至髂骨翼前部含有髂前上下棘的骨柱后再未出现医源性骨折;术后均未发生髂骨骨折及异位骨化。本组骨缺损区面积均不同程度减小,部分患者取骨缘可见乳突或齿样新骨形成,39例均无完全骨再生而使骨缺损区消失。12例因病情需要于手术前后均行CT检查,该13侧测量结果示髂骨翼骨缺损区面积均不同程度减小:术后骨缺损区面积16.8~35.9 cm2,平均(25.7±6.5) cm^2;术后12个月复查,骨缺损区面积为6.8~19.8 cm^2,平均(12.7±5.3) cm^2。结论保留髂嵴的髂骨�Objective To evaluate the clinical application effects of an iliac-crest-preserving iliac wing bone graft harvesting technique and the bone regenerative ability of the donor site after harvesting. Methods From January 2016 to June 2017, a series of 39 patients including 28 men and 11 women aged between 16 and 59 y (35±13 y in average) were prospectively collected to treat bone defects using the iliac-crest-preserving iliac wing bone graft harvesting technique. The patient cohort included 38 ipsilateral and 1 bilateral bone harvests taken from 15 femoral fracture non-unions, 8 tibial fracture non-unions, 11 femoral head necroses (hip preserving surgery), 1 tuberculosis deriving hip arthritis with bone defect (total hip arthroplasty), 2 hip prosthesis loosenings (revision), and 2 proximal femoral benign tumors. All patients were treated through comprehensive surgeries containing autologous iliac bone grafting. The surgical time, blood loss, bone graft volume, 24 h post-operative visual analogue scale (VSA) at the iliac surgical site, complications, and bone regeneration of the donor site were documented and evaluated. Results In the 39 patients (40 sides), the average surgical time was 25±4 min, average blood loss was 79±23 ml, average bone graft volume was 27±6 cm3. The average 24 h post-operative VAS at the iliac surgical site was 1.8±0.7 points. The VSA at the 6 week later and thereafter were 0 in all patients. The iliac incisions in 38 patients (39 sides) were healed uneventfully. However, seroma at the iliac surgical site emerged in 1 patient at the 6th post-operative day in the manner of serous exudation and was treated successfully with non-operative measures. None infections and lateral femoral cutaneous nerve injuries took place. Iatrogenic non-displaced iliac crest fractures happened in the very first 2 patients when taking the crest as a pivot to pry up the graft, which united without special cure at the 3 month post-operative. This complication was completely avoided when shifting the pivot to the

关 键 词：髂骨 组织和器官获取 骨移植 骨再生 

分 类 号：R687.3[医药卫生—骨科学]