Schnee C L, Freese A, Weil R J, Marcotte P J
Division of Neurosurgery, University of Pennsylvania, Philadelphia 19104, USA.
Spine (Phila Pa 1976). 1997 Oct 1;22(19):2222-7. doi: 10.1097/00007632-199710010-00005.
Retrospective study of 184 autologous iliac crest bone grafts used for anterior cervical fusion in 144 procedures.
To evaluate the effect of autologous iliac crest bone graft harvest site on operation and recovery and to identify patients at risk for harvest morbidity.
Although autologous iliac crest bone graft is considered the most successful grafting material, concerns about harvest morbidity provide a rationale for considering allograft. Data about the use of autograft therefore would assist spinal surgeons in selecting the appropriate substrates for fusion after anterior cervical decompression.
Statistical analysis based on patient gender, smoking history, obesity, and medical or pharmacologic risk factors for wound healing was used to evaluate morbidity after patient interviews and examinations. Limited assessment of radiographic outcome also was performed.
A second operation because of donor site morbidity was performed in four patients (2.8%), but only one (0.7%) with meralgia paresthetica had permanent sequelae. Superficial wound infection or dehiscence occurred in 5.6% of patients, with a disproportionate number of women, obese patients, and those with medical risk represented. Protracted wound symptoms of pain and poor cosmesis were reported in 2.8% and 3.5% of patients, respectively, and also were found in a significant number of female and obese patients. Evidence of fusion was present in 97% of cases.
Autologous iliac crest bone graft harvest results in minimal major morbidity when regional anatomy is respected and careful technique is observed. The identification of patients at risk for minor complications suggests that allograft may be appropriate in these patients; however, prospective comparison is required to identify whether graft material or technical factors determine fusion success and relative benefit.
对144例手术中使用的184块自体髂嵴骨移植进行回顾性研究。
评估自体髂嵴骨移植供区对手术及恢复的影响，并确定有供区并发症风险的患者。
尽管自体髂嵴骨移植被认为是最成功的移植材料，但对供区并发症的担忧为考虑同种异体移植提供了依据。因此，关于自体移植使用的数据将有助于脊柱外科医生在颈椎前路减压术后选择合适的融合基质。
在对患者进行访谈和检查后，基于患者性别、吸烟史、肥胖以及伤口愈合的医学或药理学风险因素进行统计分析，以评估并发症情况。还对影像学结果进行了有限的评估。
4例患者（2.8%）因供区并发症进行了二次手术，但只有1例（0.7%）患有感觉异常性股痛的患者有永久性后遗症。5.6%的患者发生了浅表伤口感染或裂开，其中女性、肥胖患者以及有医学风险的患者比例过高。分别有2.8%和3.5%的患者报告了持续性伤口疼痛症状和美容效果差的情况，在大量女性和肥胖患者中也发现了这些情况。97%的病例有融合迹象。
当尊重局部解剖结构并遵循精细技术时，自体髂嵴骨移植导致的主要并发症极少。识别有轻微并发症风险的患者表明，同种异体移植可能适用于这些患者；然而，需要进行前瞻性比较以确定是移植材料还是技术因素决定融合成功及相对益处。
