Davis Richard L, Taylor Benjamin C, Johnson Nathan, Ferrel Jason R, Castaneda Joaquin
*Department of Orthopedic Surgery, Mount Carmel Health, Columbus, OH; and †Department of Orthopaedic Surgery, Grant Medical Center, Columbus, OH.
J Orthop Trauma. 2015 Aug;29(8):370-2. doi: 10.1097/BOT.0000000000000300.
To compare retrograde versus antegrade femoral bone graft harvesting using the reamer-irrigator-aspirator system to determine whether there was any difference in intraoperative, postoperative, or patient outcome variables.
Retrospective cohort study.
Urban Level I Trauma Center.
PATIENTS/PARTICIPANTS: Ninety-four (62 antegrade and 32 retrograde procedures) consecutive adult patients who underwent femoral autologous bone graft harvesting using the Synthes reamer-irrigator-aspirator system between April 2008 and March 2013.
Amount of bone graft, perioperative fractures or other complications, and postoperative hip and/or knee pain.
There was no significant difference between demographic or medical comorbidities between the groups. There was no significant difference in the side of the graft harvest, graft volume, hospital length of stay, or the ability to ambulate on postoperative day 1. There was a significantly increased incidence of iatrogenic fracture or prophylactic nailing with antegrade reaming (4 vs. 0, P = 0.01). Average length of follow-up was 500 (range, 20-1477) days for the antegrade group and 378 (range, 19-706) days for the retrograde group. The antegrade group had a nonsignificant increased incidence of hip pain (8.1% vs. 3.1%, P = 0.66), and the retrograde group had a significantly higher incidence of knee pain (15.6% vs. 1.6%, P = 0.02) at 6-month follow-up. Neither hip nor knee complaints were present at final follow-up. No cases of delayed femur fracture, infection, or abductor and/or antalgic gait involving the donor extremity were seen at final follow-up.
This study provides support to the safety of femoral bone graft harvesting using both antegrade and retrograde techniques. Both techniques provide reliable, high-volume, nonstructural autologous bone graft with minimal associated morbidity.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较使用扩髓-冲洗-吸引系统进行股骨逆行与顺行取骨，以确定术中、术后或患者结局变量是否存在差异。
回顾性队列研究。
城市一级创伤中心。
患者/参与者：2008年4月至2013年3月期间，94例连续成年患者（62例顺行手术和32例逆行手术）使用Synthes扩髓-冲洗-吸引系统进行股骨自体骨采集。
骨移植量、围手术期骨折或其他并发症，以及术后髋部和/或膝部疼痛。
两组之间的人口统计学或内科合并症无显著差异。取骨侧、移植骨体积、住院时间或术后第1天的行走能力无显著差异。顺行扩髓时医源性骨折或预防性钉固定的发生率显著增加（4例对0例，P = 0.01）。顺行组的平均随访时间为500天（范围20 - 1477天），逆行组为378天（范围19 - 706天）。在6个月随访时，顺行组髋部疼痛发生率有非显著增加（8.1%对3.1%，P = 0.66），逆行组膝部疼痛发生率显著更高（15.6%对1.6%，P = 0.02）。末次随访时髋部和膝部均无不适主诉。末次随访时未发现股骨延迟骨折、感染或供体肢体涉及外展肌和/或止痛步态的病例。
本研究支持股骨顺行和逆行取骨技术的安全性。两种技术均能提供可靠、大量、非结构性自体骨移植，且相关发病率极低。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
