O'Malley Martin J, Sayres Stephanie C, Saleem Omar, Levine David, Roberts Matthew, Deland Jonathan T, Ellis Scott
Hospital for Special Surgery, New York, USA.
Foot Ankle Int. 2014 Jan;35(1):30-7. doi: 10.1177/1071100713511806. Epub 2013 Dec 6.
Autogenous bone grafting is commonly used as an adjuvant in foot and ankle procedures. The iliac crest and tibia are common sources of autogenous bone graft but require a separate operative site and have been reported to have significant morbidity including pain, fractures, and prolonged hospitalization. Bone grafting from the posterolateral calcaneus offers advantages such as a single operative field, ability to be done under an ankle block, and a theoretical low complication rate. We report our morbidity and complications of percutaneous calcaneal autograft bone harvest in patients undergoing foot operations.
Between 2006 and 2010, 6 foot and ankle surgeons performed a calcaneal bone graft on 393 patients undergoing foot procedures. Outcomes were measured through the use of a 4-question survey evaluating pain, subjective sensitivity at the incision site, numbness at the incision site, and limitation of shoe wear at a minimum of 1 year following the operation. Patient records were also examined for any additional complications that may have been reported.
Of the 393 patients eligible for this study, 210 patients responded at an average of 2.8 years (range, 1.2-5.8 years) after the operation (minimum 1 year). Of those, 181 patients (86.2%) reported no problems. Minor complications included 6 patients (2.9%) who experienced only incisional nerve sensitivity, 4 patients (1.9%) with only incisional pain, 4 patients (1.9%) who reported some degree of incisional numbness only, 2 patients (1.0%) who reported only shoe wear limitations, and 10 patients (4.8%) who had a combination of symptoms. Three patients (1.4%) had more significant complications, which consisted of a pathological fracture through the graft site, a calcaneal stress fracture, and 1 patient with permanent numbness along the distribution of the sural nerve.
Calcaneal bone graft was an easily accessible source of local autogenous bone graft for foot and ankle procedures. Despite the simplicity of the procedure, minor complications are not infrequent, with 13.8% of patients reporting some residual symptoms along the lateral border of the calcaneus when bone graft was obtained through an oblique incision.
Level IV, case series.
自体骨移植常用于足踝手术中作为辅助手段。髂嵴和胫骨是自体骨移植的常见来源，但需要一个单独的手术部位，并且据报道有显著的发病率，包括疼痛、骨折和住院时间延长。取自跟骨后外侧的骨移植具有一些优势，如单一手术视野、可在踝关节阻滞下进行，以及理论上较低的并发症发生率。我们报告了在接受足部手术的患者中经皮自体跟骨取骨的发病率和并发症情况。
2006年至2010年期间，6位足踝外科医生对393例接受足部手术的患者进行了跟骨骨移植。通过使用一份包含4个问题的调查问卷来评估结果，该问卷在术后至少1年时评估疼痛、切口部位的主观敏感性、切口部位的麻木感以及穿鞋受限情况。还检查了患者记录，以查找可能报告的任何其他并发症。
在符合本研究条件的393例患者中，210例患者在术后平均2.8年（范围为1.2 - 5.8年）（至少1年）进行了回复。其中，181例患者（86.2%）报告无问题。轻微并发症包括6例患者（2.9%）仅经历切口神经敏感，4例患者（1.9%）仅有切口疼痛，4例患者（1.9%）仅报告有一定程度的切口麻木，2例患者（1.0%）仅报告有穿鞋受限，以及10例患者（4.8%）有多种症状组合。3例患者（1.4%）出现了更严重的并发症，包括通过移植部位的病理性骨折、跟骨应力骨折，以及1例沿腓肠神经分布出现永久性麻木的患者。
跟骨骨移植是足踝手术中易于获取的局部自体骨移植来源。尽管该手术操作简单，但轻微并发症并不少见，当通过斜切口获取骨移植时，13.8%的患者报告在跟骨外侧缘有一些残留症状。
IV级，病例系列。
