Pfeifer R, Kobbe P, Knobe M, Pape H-C
Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
Oper Orthop Traumatol. 2011 Dec;23(5):446-52. doi: 10.1007/s00064-011-0117-8.
Autologous bone transplantation is a treatment of choice in patients with large bone defects. However, the iliac crest bone graft harvest is associated with numerous limitations: low volume of graft, long operation times, acute and chronic pain.
The reamer-irrigator-aspirator (RIA) system is used to harvest large volumes of intramedullar bone graft for surgical procedures that require bone graft, including non-unions, delayed union, and bone loss.
The RIA device should be assembled prior to the surgical procedure. The greater trochanter is used as entry point. Following the opening of the trochanteric region, a guide wire should be centrally positioned within the bone canal. Frequent fluoroscopic evaluation should be performed to assure the central position of the guide wire. Apply the advance/withdraw/pause/advance technique to maximize irrigation flow through the RIA. The guide wire could be placed in newly desired position within the condyle of the femur if more bone graft is required. While reaming, monitor the reaming head passage on both the anteroposterior and lateral planes to avoid bone perforation or excessive thinning. Remove the intramedullary bone graft from the graft filter.
Cautious ambulation on the 2nd postoperative day. In case of excessive bone thinning of the femur, partial weight bearing for 4-6 weeks is recommended.
The RIA system allows large amounts (25-90 cm3) of high quality bone graft to be harvested. This alternative technique is associated with less donor site morbidity and lower rates of minor and major complications when compared with conventional harvest methods (iliac crest).
自体骨移植是治疗大骨缺损患者的首选方法。然而，髂嵴取骨存在诸多局限性：骨移植量少、手术时间长、急慢性疼痛。
扩髓-冲洗-吸引（RIA）系统用于为需要骨移植的外科手术获取大量髓内骨移植材料，包括骨不连、延迟愈合和骨缺损。
RIA设备应在手术前组装好。以大转子作为入点。打开转子区域后，应将导丝置于骨髓腔内的中心位置。应频繁进行透视评估以确保导丝处于中心位置。应用推进/回撤/暂停/推进技术以使通过RIA的冲洗流量最大化。如果需要更多骨移植材料，可将导丝置于股骨髁内新的所需位置。在扩髓时，在前后位和侧位平面上监测扩髓钻头的通过情况，以避免骨穿孔或过度变薄。从移植过滤器中取出髓内骨移植材料。
术后第2天谨慎行走。如果股骨过度变薄，建议部分负重4至6周。
RIA系统可获取大量（25 - 90立方厘米）高质量的骨移植材料。与传统取骨方法（髂嵴）相比，这种替代技术的供区并发症更少， minor和major并发症发生率更低。 （注：原文中minor和major未明确中文含义，可根据实际医学语境进一步准确翻译，这里保留英文）
