在内侧开口楔形高位胫骨截骨术中，与自体骨移植相比，髂嵴同种异体骨移植的骨愈合率相同且手术时间缩短：一项随机对照临床试验。
Equal rates of bone healing and reduced surgical time with iliac crest allograft compared to autograft in medial opening wedge high tibial osteotomy: a randomized controlled clinical trial.
作者信息
de Paula Rafael Erthal, Pires E Albuquerque Rodrigo Sattamini, de Paula Mozella Alan, Sobral Ricardo Duran, Valente Maia Phelippe Augusto, Prinz Rafael Augusto Dantas, Couto Arnaldo Cézar, da Palma Idemar Monteiro, de Araujo Barros Cobra Hugo Alexandre, de Sousa Eduardo Branco, Cordeiro Aline
机构信息
Knee Specialized Attendance Center, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, 20940-070, Brazil.
Tissue Bank, National Institute of Traumatology and Orthopedics (INTO), Avenida Brasil 500 - Caju, Rio de Janeiro, RJ, Brazil.
出版信息
Arch Orthop Trauma Surg. 2024 Jul;144(7):3053-3061. doi: 10.1007/s00402-024-05410-6. Epub 2024 Jul 3.
INTRODUCTION
Iliac crest autograft is frequently used to fill in bone defects after osteotomies. Nonetheless, surgery for bone autograft procurement is associated with morbidity and pain at the donor site. Alternatives to it have been explored, but there is no consensus to guide their application as a routine practice in several orthopedic procedures. Thus, this study was designed to compare the efficacy and safety between iliac crest autograft and allograft in medial opening wedge high tibial osteotomy.
MATERIALS AND METHODS
Forty-seven patients with a symptomatic unilateral genu varum and an indication for high tibial osteotomy were randomly assigned to receive either autograft or allograft to fill the osteotomy site. Operative time, bone healing, and complication rates (delayed union, nonunion, superficial and deep infection, loss of correction, and hardware failure) were recorded after a one-year follow-up. Data were expressed as Mean ± Standard Deviation and considered statistically significant when p < 0.05.
RESULTS
The time to radiologic union was similar between both groups (Allograft: 2.38 ± 0.97 months vs. Autograft: 2.45 ± 0.91 months; p = 0.79). Complication rates were also similar in both groups, with one infection in the allograft group and two in the autograft group, two delayed unions in the allograft group, and three in the autograft group. The operative time differed by 11 min between the groups, being lower in the allograft group (Allograft: 65.4 ± 15.1 min vs. Autograft: 76.3 ± 15.2 min; p = 0.02).
CONCLUSION
Iliac crest allografts can be safely and effectively used in medial opening wedge high tibial osteotomy as it promotes the same rates of bone union as those achieved by autologous grafts, with the benefits of a shorter operative time.
TRIAL REGISTRATION NUMBER
U1111-1280-0637 1 December 2022, retrospectively registered.
引言
髂嵴自体骨移植常用于截骨术后填充骨缺损。然而，获取自体骨的手术会导致供区出现并发症和疼痛。人们已经探索了其替代方法，但对于在多种骨科手术中将其作为常规操作应用，尚无共识来指导。因此，本研究旨在比较髂嵴自体骨移植和同种异体骨移植在内侧开口楔形高位胫骨截骨术中的疗效和安全性。
材料与方法
47例有症状的单侧膝内翻且有高位胫骨截骨指征的患者被随机分配接受自体骨或同种异体骨移植以填充截骨部位。随访一年后记录手术时间、骨愈合情况及并发症发生率（延迟愈合、不愈合、浅表和深部感染、矫正丢失及内固定失败）。数据以均值±标准差表示，当p<0.05时认为具有统计学意义。
结果
两组的影像学愈合时间相似（同种异体骨移植组：2.38±0.97个月 vs. 自体骨移植组：2.45±0.91个月；p = 0.79）。两组的并发症发生率也相似，同种异体骨移植组有1例感染，自体骨移植组有2例；同种异体骨移植组有2例延迟愈合，自体骨移植组有3例。两组手术时间相差11分钟，同种异体骨移植组较短（同种异体骨移植组：65.4±15.1分钟 vs. 自体骨移植组：76.3±15.2分钟；p = 0.02）。
结论
髂嵴同种异体骨移植可安全有效地用于内侧开口楔形高位胫骨截骨术，因为它能促进与自体骨移植相同的骨愈合率，且具有手术时间较短的优势。
试验注册号
U1111 - 1280 - 0637，2022年12月1日回顾性注册。
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