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

Application of drilling columnar autogenous iliac bone graft and clinical analysis of postoperative complications in the donor bone region

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(P>0.05);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(P<0.05);两组术后并发症(髂骨凹陷、麻木)差异有统计学意义(P<0.05)。术后2周VAS评分两组差异无统计学意义(P>0.05),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。

Objective：To investigate the clinical effect of drilling columnar autogenous iliac bone graft and analyze the effect of bone grafting on postoperative complications in donor site. Methods：From March 2014 to October 2016,68 patients with autogenous iliac bone graft were retrospectively analyzed,and divided into drilling group and osteotomy group,34 patients in each group. In drilling group,there were 24 males and 10 females with an average age of（40.06±5.60） years old ranging from 23 to 53 years old;in osteotomy group,there were 26 males and 18 females with an average age of（39.32±6.44） ranging from 22 to 56 years old. The operative time of bone extraction,blood loss in donor area,healing time of donor site and postoperative donor site complications were observed and compared between the two groups. VAS score was used to evaluate the pain of donor site in different periods after operation. Results：All patients were followed up for 12 to 24 months,with an average of 16.9 months in drilling group and 17.1 months in osteotomy groups. The bone healing structure was displayed in the recipient area in two groups,the effect of autogenous iliac bone grafting was good. There was no significant difference in operative time between two groups（P〈0.05）. There was significant difference between two groups in the amount of donor site bleeding and the time of donor site wound healing（P〈0.05）. Postoperative complications（iliac depression and numbness） were significantly different between two groups（P〈0.05）. There was no significant difference in VAS score between two groups at 2 weeks after operation（P〈0.05）. VAS scores of drilling group at 6 months and 1 year after operation were lower than those of osteotomy group（1.85±0.61 vs 2.97±0.67,P=0.000; 1.15±0.56 vs 2.41±0.61,P=0.000）. Conclusion：When bone graft is no need to have large pieces of special shape or more cortical bone iliac,it is simple to operate and less complications postoperative by drilling type columnar autogenous iliac bone graft. What＇s more,it has the obvious advantages of promote healing,improve patient quality of life compared with traditional osteotomy.