两种取髂骨方法的临床对比分析

目的探讨操作简便、创伤小、并发症少的切取髂骨方法。方法回顾性分析本院2007年6月至2012年2月间,获得随访的取髂骨的134例患者的临床资料,按照不同的取髂骨术式分成环钻取骨组(69例)、传统的骨刀取骨组(65例)。将手术操作时间、术中出血量、术后并发症(包括髂骨骨折、髂骨凹陷、术后创口脂肪液化、疼痛、麻木)等指标作为临床评价。结果两组的平均手术占用时间无显著性差异,但术中出血量、术后各项并发症有明显差异,环钻组术中出血量及术后并发症明显低于骨刀组。结论术中无需大块特殊形状髂骨植骨时,用环钻取骨操作简便、并发症少,较传统骨刀取骨优势明显,值得临床推广使用。     

髂骨取骨术的并发症及其防治

本文简要综述了髂骨取骨术并发症及其相关解剖和防治方法。     

髂骨取骨术后并发症分析

分析髂骨取骨术后并发症成因、解决办法。通过对髂骨相关解剖、手术方法等来论述术后出现各种并发症的原因、预防措施。髂嵴取骨术虽然是一种小手术,但可以发生诸多并发症,也是一种可以做好的很有用的手术。只要严格手术指征、细致操作,熟悉供骨区的解剖关系,这些并发症大多是可以避免的。     

切取髂骨植骨术几种方法的比较

目的 探讨实用、简便、并发症少的切取髂骨方法。方法：依据临床切取髂骨块的要求，将86例切取髂骨植骨术分成三组：环锯切取髂骨术组(28例)，开窗式切取髂骨术取髂骨术组(26例)，传统的直接骨刀切取髂骨术组(32例)。将手术占用时间，切取髂骨时，术中出血量，术后并发症(包括供骨区的疼痛，麻木，感染)等指标作为临床评价。结果：三组的手术占用时间，切取髂骨量等指标无显性差异，但术中出血量和术后并发症等指标有明显差异，环锯组术中出血量和术后并发症的发生率最低。结论：在无需大块髂骨作植骨材料的前提下，以环锯切取髂骨术的效果最好．     

不同自体髂骨取骨法对患者术后的影响

目的 探讨实用、有效、并发症少的自体髂骨切取方法.方法 以术中切取骨量大小,术后供骨区的疼痛、麻木、感染、及外形等作为临床评价指标评价,采用切取髂骨外板、髂骨板全层及开窗切取矩形髂骨块3种不同自体髂骨取骨方法术后对患者的影响.结果 髂骨外板采骨量较小,切取髂骨板全层及开窗切取矩形髂骨块取骨量基本相同;开窗切取矩形髂骨块...     

环钻取骨植骨交锁髓内钉治疗胫骨中下段骨折

2009年1月～2012年4月,我科对25例胫骨中下段骨折患者采用进钉处环钻取骨、微创植骨、交锁髓内钉固定治疗,疗效满意。1材料与方法1.1病例资料本组25例,男19例,女6例,年龄23～61岁。25例均为闭合骨折。骨折按照AO分类:A2型2例,A3型2例,B1型5例,B2型6例,B3型10例。合并同侧内踝骨折1例、腓骨骨折24例。受伤至手术时间4 h～8 d。     

取髂骨植骨致股外侧皮神经损伤3例

股外侧皮神经损伤又称感觉异常性骨痛,是引起股前外侧感觉障碍的原因之一,表现为股前外侧区麻木、疼痛、烧灼酸胀感[1].单纯取髂骨植骨致股外侧皮神经损伤较为少见,国外研究表明取髂骨植骨时约有10%的股外侧皮神经存在损伤[2],国内少有报道.本院自1997年1月至2001年12月收治3例,报告如下.     

髂骨取骨术后并发症的研究进展

取自体髂骨植骨是迄今最常使用的骨移植方式,其优点是可以获得一定量较好的骨质,并可以从髂嵴的前侧或后侧取骨。虽然该技术简单,但许多文献报道其并发症较多、发生率高。因此,一些学者通过改良取骨技术、微创取骨、发明不同的取骨器械以及供区重建等方法来降低取髂骨术后并发症的发生率,且临床研究结果满意;然而,另外一些研究则显示取髂骨的并发症被放大了,传统手术与使用上述技术的远期并发症发生率并无明显差异。近年来,髓内取骨技术(Reamer-Irrigator-Aspirator,RIA)被广泛应用于临床,与取髂骨术相比具有更低的并发症发生率,并在非结构性自体骨植骨方面可取代髂骨。本文就取髂骨取骨术后并发症的研究进展做一综述。     

钻取式柱状自体髂骨植骨术应用及供骨区术后并发症的临床分析

目的:探讨钻取式柱状自体髂骨植骨术的临床疗效及分析该植骨术对供骨区术后并发症的影响。方法 :自2014年3月至2016年10月,回顾性分析自体髂骨植骨患者68例,按照取骨方式不同,分为钻取式取骨(钻取组)和骨刀式取骨(骨刀组),每组34例。钻取组男24例,女10例;年龄23~53(40.06±5.60)岁;骨刀组男26例,女8例;年龄22~54(39.32±6.44)岁;观察并比较两组患者的取骨手术时间、术中供区出血量、术后供区伤口愈合时间及术后供区并发症等,并采用VAS评分对术后不同时期供区进行疼痛评价。结果:68例患者获得随访,时间12~24个月,钻取组平均16.9个月,骨刀组平均17.1个月。两组受区显示骨愈合结构,采用自体髂骨植骨术均见效果良好。两组手术操作时间差异无统计学意义(P0.05);两组术中供区出血量及术后供区伤口愈合时间差异均有统计学意义(P0.05);两组术后并发症(髂骨凹陷、麻木)差异有统计学意义(P0.05)。术后2周VAS评分两组差异无统计学意义(P0.05),术后6个月和1年钻取组VAS评分均比骨刀组低(1.85±0.61 vs 2.97±0.67,P=0.000;1.15±0.56 vs 2.41±0.61,P=0.000)。结论:术中无须大块特殊形状或较多皮质骨髂骨植骨时,用钻取式柱状自体髂骨植骨术操作简便、术后并发症少;能促进受区早期愈合,改善患者生活质量,较传统骨刀取骨优势明显。     

带髂腰血管蒂髂骨瓣植骨融合术治疗化脓性椎间隙感染

ObjectiveTo study the anatomy of iliac bone with iliaolumbar vessel and its clinical application in the pyogenic infection of the lumbar intervertebral space.Method10 specimens of iliaolumbar vessels in 5 adult cadavers were selected.The origin,passage,branch,outer diameter and length of iliaolumbar vessels were observed.The pyogenic infection of the lumbar intervertebral disc were treated by using free vascularized iliac bone transplantation for interbody bone graft.Clinical effects and fusional time were observed.ResultsThe iliaolumbar vessels went along in stable direction and its pedicle was 11.5±1.5cm,the outer diameter at the origin 2.5±0.2mm.Solid fusion was observed for 3～4 months after the operation.There was no recurrence in 6～41 months postoperatively.ECT showed that blood circulation of the iliac bone was good.ConclusionVascularized iliac bone transplantation for interbody bone grafting is one kind of applicable method for intervertebral disc infection in L4/5 and L5/S1.     

Use of vascularized pedicle iliac bone graft in the treatment of avascular necrosis of the femoral head

A vascularized pedicle iliac bone graft was performed in patients with extensive necrosis in whom the necrotic area occupied more than two-thirds of the femoral head. The purpose of this procedure is to supply vascularity and mechanical strength to the avascular femoral head. Our series consisted of 18 hips. The patients’ age at surgery ranged from 21 to 55 years. Fourteen hips were identified as stage II and 4 hips as stage III. Iliac bone graft alone was performed in 4 stage II joints. Transtrochanteric anterior rotational osteotomy of the femoral head was done additionally in 10 stage II joints and 4 stage III joints. In the group who underwent iliac bone graft alone, the mean Japanese Orthopedic Association (JOA) score improved from 58.5 to 63.8 (mean follow-up 52 months). In the group who underwent combination procedure with osteotomy, the mean JOA score improved from 71.7 to 85.0 (mean follow-up 43 months). Stage progression was noted in 3 of 4 joints in the group who underwent iliac bone graft alone. In the group who underwent the combined procedure, stage progression was noted in 2 of 10 joints at more than 1 year after operation. A vascularized pedicle iliac bone graft to treat avascular necrosis of the femoral head is considered promising for joint preservation. Received: 19 October 2000     

Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

Background:Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8–30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN) of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals.Results:The mean followup is 12.5 years (range 3-35). The union of fractures occurred in 202 (82.8%), delayed union in 18 (7.3%), and established nonunion in 24 (9.8%) patients. Full weight bearing was permitted at 16–22 weeks after union of fractures. Mean Harris hip score at the longest followup was 85.5. Among the complications, superficial wound infection occurred in 20 (8.2%), deep infection in seven (2.9%), and coxa vara in 39 (16%) patients. Preoperative radiodensity of femoral head disappeared mostly after the union of fracture whereas fresh radiodensity of femoral head appeared in 20 (8%) patients; nine (45%) of them developed segmental collapse.Conclusion:Ununited femoral neck fractureis characterized by absorption of femoral neck, posterior cortical defect, smoothening and overriding of fracture surfaces with intervening fibrous tissues associated with or without AVN of femoral head. The above method of osteosynthesis rectified the above pathology and provided satisfactory results with union of fractures in 90.1% patients at long term followup.     

带旋髂深血管蒂髂骨瓣移植治疗青壮年股骨颈骨折

目的 探讨用带旋髂深血管蒂髂骨瓣移植治疗青壮年股骨颈骨折的方法和疗效。方法 采用带旋髂深血管蒂髂骨瓣移植加螺钉内固定,治疗青壮年股骨颈骨折１４例。结果 术后随访１年￣４年６个月,１３例骨折均愈合,示发生股骨头缺血性坏死,患侧髂关节功能恢复良好。结论 该术式能提高青壮年股骨颈骨折的愈合率,避免发生骨不连和股骨头缺血性坏死等严重并发症。     

Predictive factors for vascularized iliac bone graft for nontraumatic osteonecrosis of the femoral head

We reviewed the results of 35 operations performed on 29 patients with osteonecrosis of the femoral head in which a pedicle iliac bone was utilized. The average age was 35 years (17–62). There were 28 patients of stage 2 and 7 of stage 3; there were 17 type C-1 hips and 18 type C-2 hips. The pedicle bone was inserted in the anterolateral direction of the femoral head. The average follow-up period was 8 years and 7 months. Collapse of the femoral head occurred in 19 hip joints. Although 16 of 28 stage 2 hips showed collapse, all 7 stage 3 hips resulted in collapse. Thirteen of 17 hips did not show collapse in patients with type C-1 necrosis, whereas 15 of 18 hips developed collapse in patients with type C-2 necrosis. When the bone graft was inserted in the anterolateral direction of the femoral head, incidence of collapse was reduced. These results indicate that deep circumflex iliac pedicle bone graft may be indicated for stage 2 type C-1 necrosis, and that the penetration of the graft into the anterolateral aspect of the lesion is essential for the procedure to succeed.     

Comparison of a modified minimally invasive with an open technique following harvesting of cancellous iliac bone

The open technique for obtaining cancellous iliac bone is often used for the repair of the cleft defects of the alveolus. However, recently a number of authors have stated that the morbidity and long-term cosmesis are unacceptable. The results of a long-term retrospective study of the donor sites in 47 patients who underwent the open technique are discussed. No major long term morbidity was found but a number of minor, troublesome symptoms were revealed in 36% including, itching, discomfort, hypertrophic scars and anaesthesia. The scar was considered unacceptable with a mean of 60 mm length and 4 mm wide. A minimally invasive technique is described that produces an adequate volume of milled bone, between 1.5 mls and 4 mls, (equivalent to 3–8 mls of unmilled bone). Discomfort was minimal postoperatively, and both gait and scar showed a highly favourable outcome. This unit is no longer employing the open technique for cancellous iliac bone removal.     

生物工程骨在山羊脊柱横突间植骨融合的实验研究

目的构建一种理想的骨移植替代材料。方法以关中奶山羊为实验对象,体外分离并培养骨髓间充质干细胞（MSCs）;构建人工骨复合物,以珊瑚羟基磷灰石（CHA）为支架,加入经过血管内皮生长因子（VEGF）基因转染的MSCs为三联复合物进行联合培养;将自体髂骨和构建好的生物工程骨植入山羊腰椎横突间进行对比观察研究。结果 8周触诊发现2组均无活动度。8周后摄X线片结果显示2组均已形成骨小梁。HE染色发现,基因增强工程骨在12周形成更加成熟的骨组织。生物力学测量显示2组移植骨在最大压缩强度和弹性模量上差异无统计学意义（P〉0.05）。结论 CHAMSCs-VEGF三联成骨复合物在成骨的速度和质量上接近生物自体移植骨,有望广泛应用于临床。