| Autogenous bone is the best material to repair bone defect. Autogenous bone has shown no sign of immunological rejection, and it has merits of good osteoconduction and bone regeneration. Autologous bone graft technique is widely applied in the treatment of orthopedic diseases, such as bone defect,bone tumour, spine and joint fusion. Donor site of ilium bone is widely used in autogenous bone graft. Ilium bones consists high-quality spongy bones in large quantities which can accelerate the bone fusion of bone in bone graft area and donor site and promote the fracture healing. Therefore ilium bone fracture became a powerful weapon in the treatment of delayed union and nonunion. There are no important neurovascular located in local superficial on graft site whatever harvesting ahead or behind of ilium bone that ilium bone graft has advantage of convenience, safe and low risk.Theses benefits made ilium bone. Ilium bone graft seems simple, however, due to the influence of self anatomical features and surgical operation complications may still happen such as postoperation pain, wound infection, hematoncus, scar formation, false aneurysm, myocele, arteriovenous fistula, anterior superior spine fracture and so on. Some of the complications will gradually disappear with the passage of post operation time, but some complications will exist long-termly, especially the chronic pain on ilium donor site.In order to reduce the incidence of complications on ilium donor site, we reviewed domestic and foreign literatures to seek out the best applicable bone harvesting techniques. From anatomical structure of the ilium donor site,causes of complications, bone harvesting techniques and instruments to the reconstruction of the ilium after bone harvesting were analyzed. The result showed that there were a great diversity of ilium bone harvesting techniques as well as the complications of ilium bone harvesting, involving thecomplication rate of different repot. The causes of complications of ilium bone harvesting were complex. However, some studies indicate that complication can be avoided by providing properly handing during and after bone harvesting as well as optimizing of the operation process..Refer to the domestic and foreign literatures, we found the lack of epidemiological investigation of donor site after ilium bone graft. Therefore,the study epidemiological investigation of ilium bone graft, aiming at providing clinical references of traumatic orthopedic surgeon. In addition, we found that donor site chronic pain was the most common complication of ilium bone harvesting which could permanent existence. Some studies show that the incidence rate of poatoperative pain in three months, 6 months, and2 years after ilium bone harvesting were 29%, 38%,19%,respectively. There lacks of study showing long-time research about such poatoperative pain in published English literature at present as well as systematic study of bone regeneration after bone harvesting. In consequence, we did 10 years following-up for patients after ilium bone harvesting, particularly focused on the situation of pain and bone regeneration.The research on chronic donor site pain from ilium after bone grafting has still been in the stage of following up and case observation. People think that, if the bone grafting block is too large, the irregular bone surface stimulates after bone grafting, so there is correlation between destruction of crista iliaca outline and chronic donor site pain from ilium after iliac bone grafting, however, there lacks of supporting experimental study. Therefore,we carried out an animal experiment and observed the changes in serum level of IL-1β and PGE2 in rabbit model after iliac bone grafting, so as to verify the correlation between the size of bone grafting block and chronic donor site pain.Donor site pain after ilium bone harvesting lasts more than three months refer as chronic pain, and there were no satisfied treatment by Western medicine. We tried to use Chinese medicine to relieve the pain of patients with chronic pain. Through the domestic and foreign literatures retrieval, theresearch status and progress of awareness and treatment of pain in TCM were observed. On that basis, the study the clinical effects of “Xiaobitongluo” herbs on the treatment of such chronic pain. Results show that “Xiaobitongluo”herbs has certain curative effect on donor site chronic pain after ilium bone harvesting which has theoretical basis of TCM syndrome differentiation and modern pharmacological research, providing some valuable clinical reference for traumatic orthopedic surgeon.The innovations of this study are: 1. It was the first research about iliac bone graft epidemiology at home and abroad; 2. It was the first long follow-up about chronic pain of the iliac bone graft donor site at home and abroad, and studied the bone regeneration after bone graft systematically; 3. It was the first experimental study about the causes of chronic pain of iliac bone graft donor site at home and abroad; 4. It was the first study about Chinese medicine treatment for chronic pain of bone graft.Part 1 The epidemiological analysis of ilium removal patients and more than 10 years of long-term follow-up results of the ilium donor bonesObjective: To investigate the epidemiological characteristics of the iliac bone graft patient sand describe the results of pain and iliac regeneration associated with the iliac donor site during a 10-year follow-up of 32 patients.Methods: A retrospective clinical study was conducted in the autologous iliac bone graft patients of Third Hospital of Hebei Medical University since January 2008 to January 2013. The age, gender, reason for autologous iliac bone graft and the economic situation of each patient were recorded for further analysis in order to obtain a better epidemiological results. Reasons for autologous iliac bone graft could be divided into 5 levels:for bone defect when internal fixation of fracture was conducted; for non union after the first internal fixation surgery without bone graft; for avascular necrosis of the femoral head; for tumor resection and for tubercurosis debridement surgery.The economic situation of patients were divided into citizen and farmer two levels. Another collection is the information of adult patients from The Third Hospital of Hebei Medical University, who moved iliac bone to fracture areafor internal fixation and appeared postoperative pain, during January 2000 to December 2002. A prospective clinical study using a visual analog scale(VAS)and the iliac regeneration status(levels I–IV) as the primary outcome measure was performed in 32 patients. The VAS score was recorded at 1 month, 1 year,3 years, 5 years, and 10 years postoperatively. The iliac regeneration status was recorded at 1, 3, 5, 7, and 10 years.Results: A total of 241 patients met the inclusion criteria of this epidemiological analysis study. The average age of these 241 patients was37.08 ± 16.19 years(2-78 years old). In all the 241 patients, there were 171 male cases(71%) and 70 female cases(29%). Classifying by reasons for autologous iliac bone graft, there were 174 cases(72.2%) for bone defect when internal fixation of fracture was conducted; 32 cases(13.3%) for non union after the first internal fixation surgery without bone graft; 10 cases(4.1%) for avascular necrosis of the femoral head; 22 cases(9.1%) for tumor resection and 3 cases(1.3%) for tubercurosis debridement surgery.There were208 farmers(86.3%)and 33 citizens(13.7%) in this study. A total of 32 patients met the inclusion criteria of this long-term follow-up study. The mean VAS score at 1 month, 1 year, 3 years, 5 years, and 10 years was 3.22, 3.39,3.45, 2.02, and 1.38, respectively. There was no statistically significant difference between scores at 3 months and 1 year(P>0.05), but pairwise comparison revealed statistically significant differences between the others(P<0.05). The mean iliac regeneration ranking at 1, 3, 5, 7, and 10 years were1.36, 2.22, 2.97, 3.75, and 4.70, respectively; all pairwise comparisons were statistically significant(P <0.05).Conclusion: The autologous iliac bone graft patients were mostly young male farmers, who have relatively poor economic conditions. The most common reason was bone defect when internal fixation of fracture was conducted. The iliac donor site showed a declining trend in pain, which may have started at 3 years postoperatively. Long-term follow-up studies showed that the ilium was able to repair itself.pain from iliumObjective: To analyze correlated reasons for chronic donor site pain from ilium through animal experimental study.Methods: Experiment rabbits were divided into normal group(8)(group N) and experimental group(16) after random numbers. We randomly divided the experimental group into large irregular bone grafting group(8)(group L)and small open-window bone grafting group(8)(group S). After 3 months of rabbits’ normal feeding for every group, we respectively extracted 3ml blood from great saphenous veins of all animals before model establishment and after model establishment 3 months, which was divided into two tubes evenly,that is, 1.5ml/ tube. After high speed centrifugation, we took the supernatant liquid to detect the content of serum levels of IL-1β and PGE2 respectively.SPSS19.0 statistical software was used to analyze the gained data.Results: Detection result of serum IL-1β showed: through the comparison before and after 3 months’ of model establishment, there was significant difference in group L; and there was significant difference in group L and group S through the comparison after model establishment. Through the comparison of full thickness in each group, there wasn’t significant difference of detection result of serum IL-1β before model establishment; there was significant difference of detection result of serum IL-1β in groups L, N and S after 3 months of model establishment. Results of PGE2 showed: through the comparison before model establishment and after 3 months of model establishment, there was significant difference in group L before and after model establishment; and there was significant difference in group L and group S through the comparison after model establishment. Through the comparison of full thickness in each group, there wasn’t significant difference of detection result of serum PGE2 before model establishment; there was significant difference of detection result of serum PGE2 in groups L, N and S after 3 months of model establishment.Conclusion: If the bone grafting block was too large, the irregular bone surface stimulates after bone grafting, so there is correlation between Part 2 Experimental study on correlated reasons for chronic donor sitedestruction of crista iliaca outline and chronic donor site pain from ilium after iliac bone grafting.Part 3 The analysis about the treatment results of chronic pain from theiliac bone donor site using Xiaobitongluo herbsObjective: To analysis the treatment results of chronic pain from the iliac bone donor site using Xiaobitongluo herbsMethods: A clinical study was conducted in the patients’ iliac bone donor site in Hebei Traditional Chinese Medicine Hospital since January 2012 to December 2014(including patients suffering from chronic pain during the follow-up visit in The Third Hospital of Hebei Medical University). The age,gender and VAS scores for iliac bone donor sites were recorded. Patients were randomly divided into treatment and control groups with 16 cases in treatment group and 15 cases in control group. The treatment group took Xiaobitongluo herbs orally, while the control group took diclofenac sodium SR tablets orally by two weeks, and then VAS score was reused to evaluate patients’ chronic donor site pain situation from ilium. In addition, the patient’s serum level of IL-1β before and after treatment was observed. SPSS19.0 statistical software was used to analyze VAS score and IL-1β data before and after taking medicines.Results: There were totally 31 patients in accordance with the inclusive criteria of the research. All the wounds healed primarily, free from infection and blood oozing and fluid oozing. There was comparability between the two groups in sex, age and course of disease(P > 0.05). Through the comparison of VAS score between treatment group and control group before and after the treatment, P<0.05; the comparison of VAS score between them after the treatment, P<0.05, it can be considered that the use of Xiaobitongluo herbs for treating chronic donor site pain from ilium showed statistical significance,compared with that of control group.The difference in serum level of IL-1β between them before and after the treatment of different medicines, namely there was significant difference between patient’s serum level of IL-1β before and after treatment. Serum levelof IL-1β of group T and group C after treatment were significantly lower than that before treatment. According to the data analysis of serum level of IL-1β of two groups after treatment, P>0.05, so it can be considered the difference in serum level of IL-1β between these two groups after the treatment of different medicines had no statistical significance. It showed Xiaobitongluo herbs and diclofenac sodium sustained-release tablets had an equivalent effect to reduce the serum level of IL-1β in patients suffering from chronic donor site pain from ilium.Conclusion: The Xiaobitongluo herbs have a certain therapeutic effect for chronic donor site pain from ilium, the score based on degree of pain is superior to that of control group, but they have an equivalent effect to reduce the serum level of IL-1β in patients suffering from chronic donor site pain from ilium. |
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