RU2329000C1 - Method of iliac bone grafting - Google Patents

Abstract

FIELD: medicine; traumatology.

SUBSTANCE: invention substance implies grafting procedure of iliac crest. Thus skin is dissected with anterior superior iliac spine clearance more than 3 cm. Cortical plate of iliac crest is U-shaped sawed through. Saw is applied at an angle 45-50° to bone surface in outward-to-inward direction relative to made U-shaped graft. Cortical plate is broken at base, a formed U-shaped rag. Periosteal crus graft is thrown back caudad. Transplant is made of bone spongy substance by cylinder-shaped bone cutter. U-shaped graft is laid back and sutured behind periosteum.

EFFECT: low-traumatic bone grafting technique and prevention of numerous complications.

4 cl, 1 ex

Description

The invention relates to traumatology and orthopedics and can be used in various operations requiring replacement of bone defects of different locations. Mostly the proposed invention is used in spinal surgery.

The traditional technique for graft collection from the iliac crest involves the following sequential actions:

Make an incision along the projection of the ridge to the bone. Using a wide raspator, muscles are separated from the inner and outer surfaces of the latter over a length corresponding to the size of the graft. Then, with a chisel, a thin bone plate is knocked down from the upper surface of the ridge and turned away to the side, after which they also begin to take the graft with a chisel. Depending on the task, the graft is taken from one or both cortical plates of the iliac wing or, in general, only from the crest. The transplant can be taken in a single block of the appropriate shape and size or in the form of several fragments.

After the graft has been removed, the previously thinned thin plate of the iliac crest is sutured to its previous position (a bone defect remains underneath). A catheter is inserted into the cavity to evacuate the hematoma and the wound is sutured in layers tightly (see, for example, IA MOVSHOVICH Operational Orthopedics. M: Medicine, 1994, p. 414).

This (traditional) technique is fraught with many complications:

1) damage to the external cutaneous nerve of the thigh, which entails a violation of the sensitivity of the outer surface of the thigh;

2) damage to the tailor muscle attaching to the anterior superior iliac crest spine;

3) damage to the inguinal ligament attached to the anterior superior iliac crest spine;

4) fracture of the anterior superior spine;

5) penetration of the instrument under the internal cortical plate of the iliac crest with damage to the neurovascular formations of the iliac fossa;

6) the formation of hematomas of the postoperative wound;

7) hernia formation through a defect in the iliac crest;

8) suppuration of hematomas of the postoperative wound;

This state of affairs required us to create a less traumatic technique for taking bone grafts from the iliac crest.

Our method of taking the bone graft from the ilium differs from the known method in that they cut the skin, departing from the anterior superior spine more than 3 cm, saw through the periosteum and cortical plate of the iliac crest in a U-shape, while the saw is placed at an angle of 45-50 ° to the surface of the bone in the direction from the outside to the inside of the formed U-shaped flap, a cortical plate is broken at the base of the formed U-shaped flap (1 × 1 cm in size), folding it caudally on the periosteal leg, etc. plague taking graft from cancellous bone cutter cylindrical, laid U-shaped back flap, is fixed the U-shaped flap seams for periosteum.

Carry out the method of taking the transplant as follows.

To prevent damage to the external cutaneous nerve of the thigh, which leads to a violation of the sensitivity of the outer surface of the thigh, it is necessary to deviate from the front upper spine more than 3 cm. The skin incision is only 2 cm. After exposure of the fascia and periosteum over the iliac crest to prevent migration of the thin plate of the iliac crest an oscillating saw is sawn through the iliac crest in a U-shaped manner; further, breaking the cortical plate at the base of the formed U-shaped flap, the formed “lid” in the iliac crest is folded on the preserved periosteal leg. The angle of attack of the saw is 45-50 ° degrees to the bone surface in the direction from the outside to the inside of the formed U-shaped flap, which further prevents the formed cover from falling into the thickness of the iliac crest after it is sutured to the edge of the bone defect. After folding the lid, the spongy substance of the ileal crest is exposed, which we pick up with a cylindrical cutter with an inner diameter of 0.4 cm. Thus, we get sponge columns with a graft of 0.4 cm in diameter and up to 2.5 cm long. After taking 3-4 sponge columns We put the lid in its place in the bone and hem its periosteal edge to the surrounding periosteal edges of the wound, thereby creating a tightness of its edges, which prevents the formation of hematomas of the postoperative wound. Thanks to this technique, we also prevent the development of other complications: there is no risk of damage to the external cutaneous nerve of the thigh, the tailor muscle, which attaches to the anterior superior spine of the iliac crest; there is no risk of penetration of the instrument under the internal cortical plate of the iliac crest with damage to the neurovascular formations of the iliac fossa.

We used this technique in the surgical treatment of 41 patients. No complications were noted.

Clinical example. Patient B., 25 years old, was admitted with a diagnosis of intervertebral osteochondrosis, deforming spondylosis of the lumbosacral spine, sequestered hernia of the intervertebral disc L5-S1, segmental instability, left-sided lumbar ischialgia, prolonged course. To perform interbody fusion using cages and autologous bone, a transplant from the ilium was required. Operated according to the claimed method. A skin incision was made, deviating from the anterior superior spine more than 3 cm, the U-shaped cortical plate of the iliac crest was sawn through, the cortical plate was broken at the base of the resulting U-shaped flap, the resulting U-shaped flap was folded caudally on the periosteal leg. Then, with a cylindrical cutter, graft columns 4 mm in diameter 2-2.5 cm long from spongy bone were taken, a U-shaped flap was laid back and fixed. Using autografts taken, interbody fusion L5-S1 was performed. According to observations for 1 year, the treatment result is good, spinal fusion of the L5-S1 spine segment has been achieved. There are no circulatory disorders, sensitivity, etc. in the donor zone.

Claims (4)

1. The method of taking a bone graft from the ilium, including a skin incision, taking a graft from the iliac crest, characterized in that the skin incision, departing from the anterior superior spine more than 3 cm, saw through a cortical plate of the iliac crest U-shaped, while the saw is placed at an angle of 45-50 ° to the bone surface in the direction from the outside to the inside of the formed U-shaped flap, the cortical plate is broken at the base of the formed U-shaped flap, folding it onto the periosteal Shank minutes caudally produce taking graft from cancellous bone cutter cylindrical, laid U-shaped back flap, is fixed the U-shaped flap seams for periosteum. 2. The method according to claim 1, characterized in that the U-shaped flap has a size of 1 × 1 cm 3. The method according to claim 1, characterized in that they take bone grafts with a diameter of 0.4 cm and a length of up to 2.5 cm 4. The method according to claim 1, characterized in that they take bone grafts with a cylindrical cutter with an inner diameter of 0.4 cm