微创定点髂后棘取骨的临床研究

Clinical Study of Minimally Invasive Bone Harvest From Fixed Site of Posterior Iliac Crest

目的探讨微创定点髂后棘取骨的可行性及临床效果。方法2012年6月至2018年5月收治需植骨的骨延迟愈合、骨不连患者40例,随机分为实验组和对照组,每组20例。实验组采用微创定点髂后嵴取骨,对照组采用传统开放性取骨。统计并分析两组的手术时间、手术切口长度、术中出血量、术后并发症发生率等,并随访植骨后治疗骨延迟愈合、骨不连的骨愈合情况。结果a、实验组:手术时间为(15.70±3.61)min,手术切口长度(1.42±0.28)cm,手术出血(16.05±4.72)mL,术后伤口均Ⅰ期愈合。局部血肿是唯一的并发症,3例患者出现局部血肿,均可自行消退,无严重并发症发生。对照组:手术时间(37.90±4.99)min,手术切口长度(5.02±0.50)cm,手术出血(49.50±8.72)mL,术后2例出现伤口感染、愈合不良,2例出现股外侧皮神经损伤,3例出现取骨部疼痛,2例出现髂骨凹陷。b、两组手术时间、切口长度及手术出血对比,实验组显著低于对照组(P<0.01)。术后并发症的发生率等比较差异有统计学意义(P<0.05),两组植骨后治疗骨延迟愈合、骨不连的骨性愈合率差异无统计学意义(P>0.05)。结论微创定点髂后棘取骨与传统开放性取骨,均可达到自体髂骨移植的目的,但微创定点髂后棘取骨具有手术损伤小、出血少、操作简便、并发症少等优点,值得临床推广。

Objective To explore the feasibility and clinical effect of minimally invasive bone harvest from fixed site of posterior iliac crest.Methods From June 2012 to May 2018,40 patients with delayed union and nonunion required bone graft were randomly divided into experimental group and control group.There were 20 cases in each group.The experimental group was treated with minimally invasive posterior iliac crest bone harvest,while the control group was treated with traditional open bone harvest.The operation time,incision length,blood loss during operation and postoperative complications were analyzed,and the bone healing of delayed union and nonunion were followed up.Results In experimental group,the operation time was(15.70±3.61)min,the incision length was(1.42±0.28)cm,the operative bleeding was(16.05±4.72)mL,the wound healed as expected.Local Hematoma was the only complication.In 3 cases,local hematoma appeared and could subside without serious complication.Incontrol Group,theoperation time was(37.90±4.99)min,incision length was(5.02±0.50)cm,operative bleeding was(49.50±8.72)mL,wound infection and poor healing in 2 cases,injury of lateral femoral cutaneous nerve in 2 cases,bone pain in 3 cases and iliac bone depression in 2 cases.The operation time,incision length and bleeding of the two groups were significantly lower than that of the control group(P<0.01).There were significant differences in the incidence of postoperative complications(P<0.05).There was no significant difference in the bone healing rate of delayed union and nonunion between the two groups(P>0.05).Conclusion Both minimally invasive posterior iliac crest osteotomy and traditional open bone harvest can achieve the goal of autologous iliac bone grafting,but minimally invasive posterior iliac crest bone harvest has the advantages of less surgical injury,less bleeding,simple operation and fewer complications.