[Clinical application of rib autograft for iliac crest reconstruction by anterior approach of thoracic and lumbar vertebrae].

OBJECTIVE

To explore the clinical application of rib autograft for reconstructing iliac crest by anterior approach of thoracic and lumbar vertebrae, and to observe the short-term and long-term effects.

METHODS

From September 2004 to September 2007, 54 cases of thoracic and lumbar injuries were treated by the surgery of anterior approach of thoracic and lumbar vertebrae. There were 39 males and 15 females with an average age of 42 years old (range, 27-59 years old), including 4 cases of tuberculosis of spine and 50 cases of thoracic and lumbar vertebrae bursting fracture. All cases underwent the surgery of anterior approach of thoracic or lumbar and iliac crest was used as autograft. Fifty-four patients were randomized into the reconstruction group (RG, n = 25) and the non-reconstruction group (NRG, n = 29). The patients of RG group were treated with rib autograft for reconstructing iliac crest. There were no statistically significant differences in general data between two groups (P > 0.05). The visual analogue scores (VAS) was used to estimate pain degree of treated hip after 2 weeks, and 3, 12 months. The extension satisfaction grade of iliac crest and the comfort degree of action while bundling waist belt were estimated after 12 months. It was observed whether or not anterior superior iliac spine avulsion fracture occurred on the premise of non-accidental trauma within 1 year. The occurrence of fracture and the union status of reconstructed iliac crest were observed by X-ray after 1 year.

RESULTS

All wounds achieved primary healing. No complication was found at early stage. All patients were followed up 1 year. There was no significant difference in the VAS of the treated hip under conditions of clinostatism rest between two groups after 2 weeks and 3 months (P > 0.05). But there was significant difference in the VAS under conditions of action after 2 weeks and 3 months, under conditions of clinostatism rest after 12 months (P < 0.05), and the VAS of RG was lower than that of NRG. The exterior satisfaction grade of iliac crest and comfort degree of action while bundling waist belt in RG were higher than those in NRG after 1 year, showing significant differences (P < 0.05). No anterior superior iliac spine avulsion fracture occurred after 1 year. And in RG group no fracture of reconstructed iliac crest occurred after 1 year. The X-ray film showed that the two ends of rib reconstructed by iliac crest were blur, and that the rib healed well with iliac bone.

CONCLUSION

Rib autograft for reconstruction of iliac crest by anterior approach of thoracic and lumbar vertebrae was economic and convenient. It could improve local appearance, reduce the local pain, and improve patients' life quality.