Iliac Crest Bone Graft Harvesting: Prospective Study Of Various Techniques And Donor Site Morbidity

摘要

Background - Harvesting autograft bone from the ilium is not without complications. When cases are reported in follow-ups, investigators usually concentrate upon treatment outcome of the principle problems and not on the donor site morbidity from harvesting a bone graft. The purpose of our study is to assess the complications related to bone grafting site of iliac crest, simultaneously evaluation and assessment of various techniques used for harvesting the bone graft from the iliac crest. Material and methods - 56 patients were included in our study, which fulfilled the criteria of at least 6 months follow up. Bone graft was harvested from anterior or posterior iliac crest by wolfe-kawamoto’s, outer cortex, inner cortex and tricortical graft harvesting and trephine techniques. Results – Graft harvested from anterior crest in 49 cases (88%), posterior crest in 6 cases (11%) and bilateral anterior crest in 1 (1.8%). Graft harvesting techniques- wolfe-kaamoto’s used in 15(27%), outer cortex in 30 patients (55%), inner cortex in 1(1.8%), and tricortical in 8(14%) and trephine method in 1(1.8%) patient. Average amount of graft harvested from posterior cortex was more compared to anterior crest (13.3/9.6 gm). Donor site complications- infection rate 7.2% (superficial- 3 patients, deep- 1 patient), hematoma 1.8% (n-1), cutaneous nerve injury 14.3% (temporary loss of sensation 3, residual loss in 5 patients), donor site pain 10.6% (temporary- 5, residual- 1) and direct incomplete hernia in 1 patient (1.8%). Total donor site morbidity was (35.6%)[minor complications in 21.4%(n-12) and major complications in 14.2%(n-8)]. Conclusion- Harvesting bone graft from iliac crest is not without complications. Injury to the cutaneous nerve around the crest constitutes the major component of morbidity after iliac crest bone graft harvesting. Introduction The principles, indications and techniques of bone grafting were well established before “ the metallurgic age” of orthopedic surgery. Church literature presented the first mention of bone transplantation in 1682. The first successful autograft was reported by Dr. P. Von Walther in 1820 and Macewen, 58 years later using an aseptic technique performed the first successful autograft bone transplant. Anterior and posterior iliac crest are good sources of large cancellous and cortico-cancellous graft. If the patient is prone, posterior third of ilium is used, if supine, the anterior third is available. There are various methods of graft harvesting from iliac crest- graft from outer cortex, graft from inner cortex, wolfe-kawamoto’s method, tricortical graft, “trap-door” technique, “table-splitting” method and trephine technique1, 5. Many studies reporting on the morbidity of the iliac crest bone graft have reported overall complications ranging from 15% to 49%3,4. Complications that have been enlisted are infection, hernia, fracture, pelvic instability, nerve injury, ureteral injury, chronic pain, hematoma, gait abnormality, superior gluteal artery injury and enterocutaneous fistula2, 4,5,6,7,8,9,10,11. Complications at donor site can be divided into minor and major, definition, which has been provided, by Younger and Chapman12. Minor complications were defined as self-limited events that did not require an additional surgical procedure and responded to non-operative management. Major complications were those that led prolonged hospitalization and required additional surgery. The purpose of our study is to assess the complications related to bone grafting site of iliac crest, simultaneously evaluation and assessment of various techniques used for harvesting the bone graft from the iliac crest. Material and Methds 56 patients who had undergone iliac crest bone graft harvesting between September2003-September2004 were studied retrospectively. There were 50 females and 6 males, most of the patients were between 20-30 age group (n-22). Most common indication for iliac crest bone graft harvesting was fresh