Chinese Journal of Reparative and Reconstructive Surgery, April 2011, Vol. 25, No.4· 462·新型取骨器的临床应用范伟杰 谢雪松【摘 要】 目 的 观察“洛阳铲” 式新型取骨器的临床应用效果。 方法 2006 年 8 月 － 2009 年 10 月 行自 体髂骨移植术并获随访 112 例， 其中男 71 例， 女 41 例； 年龄 11 ～ 71 岁， 中位年龄 42 岁。 四肢粉碎性骨折 45 例， 骨不连 47 例，良性骨肿瘤 20 例。 采用新型取骨法 （A 组） 32 例、三面皮质取骨法 （B 组） 29 例、内板取骨法 （C 组） 15 例、外板取骨法 （D组） 23 例、环钻双面皮质取骨法 （E 组） 13 例。 各组患者术前一般资料比较差异无统计学意义 （P > 0.05）。 比较各组手术切口长度、手术时间、术中出血量及术后 4、 7、 60 d 和术后 1 年疼痛视觉模拟评分 （VAS）， 并观察术后周围神经损伤、骨折、血肿、腹疝、髂嵴凹陷、慢性疼痛发生率。 结果 A 组手术切口长度、手术时间、术中出血量及术后各时间点 VAS 评分均优于其余各组， 比较差异均有统计学意义 （P < 0.05）。 A 组与 B 组比较术后 1 年慢性疼痛及髂嵴凹陷发生率差异有统计学意义 （P < 0.01）； 与 C、 D、 E 组比较周围神经损伤、骨折、血肿、腹疝、髂嵴凹陷、慢性疼痛发生率及与 B 组比较周围神经损伤、骨折、血肿、腹疝发生率， 差异无统计学意义 （P > 0.05）。 但 A 组 6 项并发症总例数明显少于其余 4 组， 差异有统计学意义 （P < 0.05）。 结论 新型取骨法是一种微创的取骨方法， 具有切口长度短、手术时间短、出血量少、术后疼痛程度轻、并发症少的特点。【关键词】 骨移植 髂骨 并发症 新型取骨器CLINICAL APPLICATION OF NEW BONE HARVESTER/FAN Weijie, XIE Xuesong. Department of Orthopedics, the First Affiliated Hospital, University of South China, Hengyang Hunan, 421001, P.R.China. Corresponding author: FAN Weijie, E-mail:flygreatman@126.com 【Abstract】 Objective To investigate the clinical application effect of the new bone harvester. Methods Between August 2006 and October 2009, 112 patients underwent autogenous iliac bone graft and were followed up. There were 71 males and 41 females with a median age of 42 years (range, 11-71 years), including 45 cases of comminuted fracture of the limbs, 47 cases of bone nonunion, and 20 cases of benign bone tumor. According to different methods of bone harvesting, the patients were divided into 5 groups: group A (n=32, with new bone harvester), group B (n=29, with tricortical bone harvester), group C (n=15, with internal lamina harvester), group D (n=23, with external lamina harvester), and group E (n=13, with bicortical iliac bone by saw). There was no significant difference in general data of 5 groups (P > 0.05). The incision length, operation time, and peri-operative bleeding volume were compared. At 4 days, 7 days, 60 days, and 1 year postoperatively, the pain degree was assessed using visual analogue scale (VAS), and the incidence rates of peripheral nerve injury, fracture, haematoma, ventral hernia, iliac crest sag, and chronic pain were observed. Results The incision length and the operation time in group A was shorter than those in other groups, the peri-operative bleeding volume in group A was less than in other groups, the VAS in group A was the lowest among 5 groups, showing significant differences (P < 0.05). The occurrence rates of chronic pain and iliac crest sag in group A were lower than those in group B, showing significant differences at 1 year after operation (P < 0.01). There was no significant difference in the incidence rates of peripheral nerve injury, fracture, haematoma, ventral hernia, iliac crest sag, and chronic pain between group A and groups C, D, E (P > 0.05), and in the incidence rates of peripheral nerve injury, fracture, haematoma, and ventral hernia between group A and group B (P > 0.05). The total complication in group A was the lowest among 5 groups, showing significant difference (P < 0.05). Conclusion The new bone harvester is minimally invasive bone harvester, which has the advantages of short operation time and incision length, less bleeding volume, low VAS and complications.【Key words】 Bone graft Ilium Complication New bone harvesterFoundation item: Research Program of Hunan Medical Health (ZD02-22)自 体髂骨移植术是骨科常用手术。 然而常规的基金项目： 湖南省医药卫生科研课题计划项目（ZD02-22）作者单位： 南华大学附属第一医院骨科 （湖南衡阳， 421001）通讯作者： 范伟杰， 副教授， 硕士生导师， 研究方向： 四肢组织缺损的修复重建， E-mail: flygreatman@126.com网络出版时间： 2011-3-8 15:51:02； 网络出版地址： http://www.cnki.net/kcms/detail/51.1372.R.20110308.1551.201104.78_145.html自 体髂骨取骨方法， 包括三皮质取骨法、内板取骨法、外板取骨法、环锯取骨法等， 可导致周围神经损伤、供骨区疼痛、血肿、感染、腹疝及供骨区外形改变等并发症[1-3]。 为此， 我们参照考古工作者使用的“洛阳铲” 原理， 结合骨科中使用的环钻原理， 发明了“洛阳铲” 式新型取骨器， 并应用于临床， 可较传统常用的取骨方法
