Robertson P A, Wray A C
Neurosurgery, Auckland Hospital, New Zealand.
Spine (Phila Pa 1976). 2001 Jul 1;26(13):1473-6. doi: 10.1097/00007632-200107010-00018.
A prospective study was conducted to examine bone graft donor site morbidity in 106 consecutive patients undergoing posterior spinal fusion.
To perform a prospective analysis of donor site morbidity, to document the incidence of major complications, and to collect information on the impact of autologous bone graft harvesting from the posterior iliac crest on the overall outcome of spinal surgery.
Bone graft harvesting from the posterior iliac crest for spinal fusion is a source of significant morbidity. Previous retrospective case studies indicate that minor complications are common, but they do not define the natural history and complications of posterior iliac crest bone graft harvesting.
A standardized harvesting technique was used. At 3, 6, and 12 months after surgery, the patients completed a proforma questionnaire rating symptoms on a visual analog scale and underwent a postoperative examination by the surgeon. Finally, overall surgical outcome was assessed at 12 months.
The major component of morbidity is donor site pain. Mean pain scores were 1.640 at 3 months, 1.812 at 6 months, and 1.207 at 12 months. The pain at 12 months was significantly less than at 3 and 6 months (P = 0.005), with a trend toward the highest scores at 6 months. A pain score of 0 was reported by 55% of the patients. Local sensory loss was found in 10% of the patients. Outcome assessment showed significant differences in morbidity for surgery performed at different spinal levels (P = 0.001), with lumbosacral surgery resulting in worse outcomes than either cervical (P < 0.05) or thoracolumbar (P < 0.05) surgery. Significantly higher visual analog scores were observed at 6 months in patients with poorer overall outcomes.
According to this study, it is reasonable to reassure patients that a good result from spinal surgery will not be compromised by severe symptoms or major morbidity secondary to posterior iliac crest bone graft donation. Before surgery, patients may be advised concerning the risks of donor site pain, which improves significantly by 12 months, local tenderness, and uncommonly localized sensory loss.
开展一项前瞻性研究，以检查106例连续接受后路脊柱融合术患者的骨移植供区并发症情况。
对供区并发症进行前瞻性分析，记录主要并发症的发生率，并收集有关从髂后嵴获取自体骨移植对脊柱手术总体结果影响的信息。
从髂后嵴获取骨移植用于脊柱融合是显著并发症的一个来源。既往回顾性病例研究表明轻微并发症很常见，但它们并未明确髂后嵴骨移植的自然病程和并发症情况。
采用标准化的获取技术。在术后3个月、6个月和12个月，患者完成一份表格问卷，用视觉模拟量表对症状进行评分，并接受外科医生的术后检查。最后，在12个月时评估总体手术结果。
并发症的主要组成部分是供区疼痛。平均疼痛评分在3个月时为1.640，6个月时为1.812，12个月时为1.207。12个月时的疼痛明显低于3个月和6个月时（P = 0.005），6个月时疼痛评分有达到最高的趋势。55%的患者报告疼痛评分为0。10%的患者存在局部感觉丧失。结果评估显示，在不同脊柱节段进行手术的并发症存在显著差异（P = 0.001），腰骶部手术的结果比颈椎手术（P < 0.05）或胸腰段手术（P < 0.05）更差。总体结果较差的患者在6个月时观察到明显更高的视觉模拟评分。
根据本研究，向患者保证脊柱手术的良好结果不会因髂后嵴骨移植继发的严重症状或主要并发症而受到影响是合理的。在手术前，可以告知患者供区疼痛的风险，这种疼痛在12个月时会显著改善，还有局部压痛以及罕见出现的局部感觉丧失。
