Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes
Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes
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DOI：
10.2106/00004623-200205000-00003
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发表时间：
2002-05-01
影响因子：
5.3
通讯作者：
Holtom, P
中科院分区：
文献类型：
--
作者：
Ahlmann, E;Patzakis, M;Holtom, P
背景：先前的研究表明，取自髂骨移植后的并发症发生率很高。方法：对1991~1998年间收治的88例慢性骨髓炎患者的临床资料进行回顾性分析，记录其人口学特征、取骨部位、取骨量、术中出血量、术后并发症等。58例患者完成了关于术后疼痛和残余疼痛、感觉障碍、功能受限、美容外观和对植骨获取程序的总体满意度的问卷调查。结果：至少在术后2年内，66个前部植骨和42个后部植骨取骨点被评估。主要并发症发生在66个前部中的8%(5个)和42个后部中的2%(1个)。并发症发生率分别为15%(10例)和0%(10例)。在整个系列中，有10个轻微并发症(9%)和6个重大并发症(6%)。前部手术后轻微并发症的发生率(p=0.006)和全部并发症的发生率(p=0.004)均显著高于后部手术后。供体部位术后疼痛明显加重(p=0.0016)，持续时间明显延长(p=0.0017)。在最近的随访评估中，没有患者报告功能受限。结论：在本系列研究中，并发症发生率低于其他研究者报道的。取自后髂骨植骨与术后并发症的风险显著降低相关。根据这项研究的结果，我们建议尽可能在后方切取髂骨植骨。
Background: Previous studies have demonstrated high complication rates after harvest of iliac crest bone grafts. This study was undertaken to compare the morbidity related to the harvest of anterior iliac crest bone graft with that related to the harvest of posterior iliac crest bone graft and to determine differences in functional outcome.Methods: The medical records of eighty-eight consecutive patients who had undergone a total of 108 iliac crest bone-grafting procedures for the treatment of chronic osteomyelitis from 1991 to 1998 were retrospectively reviewed, Demographic characteristics, the location of the harvest, the volume of bone graft that was harvested, the estimated blood loss, and postoperative complications were recorded. Fifty-eight patients completed a questionnaire pertaining to postoperative and residual pain, sensory disturbances, functional limitations, cosmetic appearance, and overall satisfaction with the bone-graft harvesting procedure.Results: Sixty-six anterior and forty-two posterior bone-graft harvest sites were evaluated at a minimum of two years after the operation. A major complication was associated with 8% (five) of the sixty-six anterior sites and 2% (one) of the forty-two posterior sites. The rates of minor complications were 15% (ten) and 0%, respectively. In the series as a whole, there were ten minor complications (9%) and six major complications (6%). The rates of both minor complications (p = 0.006) and all complications (p = 0.004) were significantly higher after the anterior harvest procedures than they were after the posterior procedures. The postoperative pain at the donor site was significantly more severe (p = 0.0016) and of significantly greater duration (p = 0.0017) after the anterior harvests. No patient reported functional limitations at the latest follow-up evaluation.Conclusions: In this series, the complication rate was lower than those previously reported by other investigators. Harvest of a posterior iliac crest bone graft was associated with a significantly lower risk of postoperative complications. On the basis of the results of this study, we recommend that iliac crest bone graft be harvested posteriorly whenever possible.