Todd Anna R, Fitzpatrick Shannon, Cawthorn Thomas R, Fraulin Frankie O G, Robertson Harrop A
University of Calgary, Calgary, Alberta, Canada.
Alberta Children's Hospital, Calgary, Alberta, Canada.
Plast Surg (Oakv). 2024 Feb;32(1):78-85. doi: 10.1177/22925503221088840. Epub 2022 Mar 30.
In the course of developing a standardized pathway for alveolar cleft repair, we conducted a systematic review comparing minimally invasive trephine with conventional open technique for iliac crest bone graft harvest in a pediatric population. A systematic review was conducted of studies comparing open with minimally invasive trephine techniques in pediatric populations undergoing alveolar cleft repair. Exclusion criteria included reviews, case series, editorials, abstracts, and those with adult-only populations. Data were compiled with outcome variables selected . Of 422 manuscripts screened, five met criteria. These comprised 257 patients (116 open, 141 trephine). Average age was 11 years. Patients undergoing trephine harvest had reduced length of stay (1.0-5.0 days trephine vs 1.25-5.4 days open), time to unassisted ambulation (16-46 hours vs 20-67 hours open), and less postoperative narcotic use (0.31 mg/kg vs 1.64 mg/kg IV morphine). Volume of cancellous bone was reported as 2.53 mL for open versus 1.22 mL for trephine in one study, and trephine graft was supplemented with demineralized bone in 54% of cases in another study. The use of anesthetic adjuncts was inconsistent but had a significant effect on postoperative pain and ambulation. Compared to open techniques, the minimally invasive trephine bone graft harvest is associated with a shorter time to discharge, slightly lower infection rates, and reduced opioid use. The possible benefits of trephine harvest must however be balanced against the risk of insufficient graft harvest. Finally, the choice of perioperative analgesic adjuncts significantly impacts patient outcomes regardless of the technique employed.
在制定牙槽嵴裂修复标准化路径的过程中，我们进行了一项系统评价，比较了微创环钻术与传统开放技术在儿科人群中获取髂嵴骨移植材料的情况。对在接受牙槽嵴裂修复的儿科人群中比较开放技术与微创环钻术的研究进行了系统评价。排除标准包括综述、病例系列、社论、摘要以及仅涉及成人人群的研究。收集了选定的结果变量数据。在筛选的422篇手稿中，有5篇符合标准。这些研究共纳入257例患者（116例采用开放技术，141例采用环钻术）。平均年龄为11岁。采用环钻术获取移植材料的患者住院时间缩短（环钻术为1.0 - 5.0天，开放技术为1.25 - 5.4天），自主行走时间缩短（环钻术为16 - 46小时，开放技术为20 - 67小时），术后麻醉剂使用量减少（环钻术为0.31 mg/kg，开放技术为1.64 mg/kg静脉注射吗啡）。一项研究报告开放技术获取的松质骨量为2.53 mL，环钻术为1.22 mL；另一项研究中，54%的环钻术移植病例补充了脱矿骨。麻醉辅助剂的使用情况不一致，但对术后疼痛和行走有显著影响。与开放技术相比，微创环钻术获取骨移植材料与出院时间缩短、感染率略低以及阿片类药物使用减少有关。然而，环钻术获取移植材料的潜在益处必须与获取的移植材料不足的风险相权衡。最后，无论采用何种技术，围手术期镇痛辅助剂的选择都会显著影响患者的预后。
