Schwartz Carolyn E, Martha Julia F, Kowalski Paulette, Wang David A, Bode Rita, Li Ling, Kim David H
Department of Orthopedics, New England Baptist Hospital, Boston, Masschusetts, USA.
Health Qual Life Outcomes. 2009 May 29;7:49. doi: 10.1186/1477-7525-7-49.
Autogenous Iliac Crest Bone Graft (ICBG) has been the "gold standard" for spinal fusion. However, bone graft harvest may lead to complications, such as chronic pain, numbness, and poor cosmesis. The long-term impact of these complications on patient function and well-being has not been established but is critical in determining the value of expensive bone graft substitutes such as recombinant bone morphogenic protein. We thus aimed to investigate the long-term complications of ICBG. Our second aim was to evaluate the psychometric properties of a new measure of ICBG morbidity that would be useful for appropriately gauging spinal surgery outcomes.
Prospective study of patients undergoing spinal fusion surgery with autologous ICBG. The SF-36v2, Oswestry Disability Index, and a new 14-item follow-up questionnaire addressing persistent pain, functional limitation, and cosmesis were administered with an 83% response rate. Multiple regression analyses examined the independent effect of ICBG complications on physical and mental health and disability.
The study population included 170 patients with a mean age of 51.1 years (SD = 12.2) and balanced gender (48% male). Lumbar fusion patients predominated (lumbar = 148; cervical n = 22). At 3.5 years mean follow-up, 5% of patients reported being bothered by harvest site scar appearance, 24% reported harvest site numbness, and 13% reported the numbness as bothersome. Harvest site pain resulted in difficulty with household chores (19%), recreational activity (18%), walking (16%), sexual activity (16%), work activity (10%), and irritation from clothing (9%). Multivariate regression analyses revealed that persistent ICBG complications 3.5 years post-surgery were associated with significantly worse disability and showed a trend association with worse physical health, after adjusting for age, workers' compensation status, surgical site pain, and arm or leg pain. There was no association between ICBG complications and mental health in the multivariate model.
Chronic ICBG harvest site pain and discomfort is reported by a significant percentage of patients undergoing this procedure more than three years following surgery, and these complications are associated with worse patient-reported disability. Future studies should consider employing a control group that does not include autologous bone graft harvest, e.g., a group utilizing rhBMP, to determine whether eliminating harvest-site morbidity does indeed lead to observable improvement in clinical outcome sufficient to justify the increased cost of bone graft substitutes.
自体髂嵴骨移植（ICBG）一直是脊柱融合的“金标准”。然而，取骨可能会导致并发症，如慢性疼痛、麻木和美观不佳。这些并发症对患者功能和健康的长期影响尚未明确，但对于确定诸如重组骨形态发生蛋白等昂贵骨移植替代物的价值至关重要。因此，我们旨在研究ICBG的长期并发症。我们的第二个目标是评估一种新的ICBG发病率测量方法的心理测量特性，该方法将有助于适当地衡量脊柱手术结果。
对接受自体ICBG脊柱融合手术的患者进行前瞻性研究。采用SF - 36v2、Oswestry功能障碍指数以及一份新的包含14个项目的随访问卷，内容涉及持续性疼痛、功能受限和美观情况，应答率为83%。多元回归分析研究了ICBG并发症对身心健康和功能障碍的独立影响。
研究人群包括170例患者，平均年龄51.1岁（标准差 = 12.2），性别均衡（男性占48%）。腰椎融合患者占多数（腰椎 = 148例；颈椎 = 22例）。平均随访3.5年时，5%的患者表示受取骨部位瘢痕外观困扰，24%的患者报告取骨部位麻木，13%的患者认为麻木令人烦恼。取骨部位疼痛导致做家务困难（19%）、娱乐活动困难（18%）、行走困难（16%）、性活动困难（16%）、工作活动困难（10%）以及衣物摩擦不适（9%）。多变量回归分析显示，术后3.5年持续存在的ICBG并发症与功能障碍显著恶化相关，在调整年龄、工伤赔偿状况、手术部位疼痛以及手臂或腿部疼痛后，与身体健康恶化呈趋势性关联。在多变量模型中，ICBG并发症与心理健康无关联。
相当比例接受该手术的患者在术后三年多报告有慢性ICBG取骨部位疼痛和不适，这些并发症与患者报告的功能障碍加重相关。未来研究应考虑采用不包括自体骨移植取骨的对照组，例如使用重组人骨形态发生蛋白的组，以确定消除取骨部位发病率是否确实能导致临床结果有可观察到的改善，足以证明骨移植替代物成本增加的合理性。
