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Knochenspanentnahme am Becken

Techniken und Probleme

Bone harvesting from the iliac crest

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Zusammenfassung

Hintergrund

Die Knochenspanentnahme am Becken ist ein häufig durchgeführter Standardeingriff zur heterotopen autologen Knochentransplantation. Obwohl mit dem gewonnenen Knochen die osteogene Potenz in einer ossären Defektzone durch autologe Transplantate lokal gesteigert werden kann, führt der Zweiteingriff nicht selten zu einer zusätzlichen Patientenmorbidität oder persistierenden Beschwerden.

Methoden

Es werden Technik und Besonderheiten der Knochenspanentnahme am Beckenkamm dargestellt und die klinische Relevanz durch eine umfassende Literaturrecherche einer entnahmebedingten Morbidität erläutert. Eigene Erfahrungen zur Knochenentnahme und deren Alternativen werden kritisch mit Arbeiten aus der wissenschaftlichen Literatur verglichen und diskutiert.

Ergebnisse

Die steigende Anzahl von wissenschaftlichen Publikationen der letzten Jahre, die sich mit dem Thema der Knochenspanentnahme beschäftigen, spiegelt das wachsende Interesse und die hohe thematische Relevanz wieder. In der Behandlung von Knochendefekten findet eine Zunahme von Alternativen wie z. B. die Applikation von Biomaterialien statt, während die Effektivität und die Effizienz von Wachstumsfaktoren und Zelltherapeutika derzeit noch überwiegend in experimentellen und klinischen Studien untersucht wird.

Schlussfolgerung

Obwohl die autologe heterotope Knochentransplantation noch immer der „golden standard“ in der Behandlung von ossären Defekten ist, besteht ein deutlicher klinischer und wissenschaftlicher Trend hin zu Alternativen wie z. B. Biomaterialien, stammzellbasierter Therapie sowie Wachstumsfaktoren. Die Berücksichtigung von anatomischen Besonderheiten kann bei der Knochenspanentnahme zur Risikominimierung von Komplikationen führen.

Abstract

Background

Autogenous bone grafts from the iliac crest are frequently harvested for autologous bone transplantation. Although an autologous bone transplant does improve the local bone healing potency, significant donor site morbidity must be considered.

Methods

In this study we elucidate special bone harvesting techniques from the iliac crest and review the literature related to clinical significance of donor site morbidity. Furthermore, our own experiences are compared and discussed critically with relevant data of other investigators.

Results

The increasing number of scientific publications which focus on bone harvesting techniques and related complications in recent years indicate the high interest and relevance of this issue. There is a tendency to alternatives such as biomaterials as bone substitutes, whereas the role of growth factors and cell therapeutics in the treatment of bony defects are still being evaluated in clinical studies.

Conclusion

Although autologous, heterotopic bone transplantation is still the gold standard in the treatment of bony defects, there is a tendency towards the application of biomaterials, stem cells, and growth factors. Conscientious observation of relevant anatomic considerations during bone harvesting procedures may help to avoid complications.

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Literatur

  1. Ahlmann E, Patzakis M, Roidis N, Shepherd L, Holtom P (2002) Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am 84(5): 716–720

    Article  PubMed  Google Scholar 

  2. An HS, Balderston RA (1991) Complications in scoliosis, kyphosis, and spondylolisthesis surgery. In: Balderston RA, An HA (eds) Complications in spinal surgery. Saunders, Philadelphia, S 20–22

  3. An HS, Simpson JM, Glover JM, Stephany J (1995) Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion. A prospective multicenter study. Spine 20(20): 2211–216

    PubMed  Google Scholar 

  4. Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA (1996) Complications of iliac crest bone graft harvesting. Clin Orthop 329: 300–309

    Article  PubMed  Google Scholar 

  5. Baselga J, Reich L, Doherty M, Gulati S (1991) Fat embolism syndrome following bone marrow harvesting. Bone Marrow Transplant 7(6): 485–486

    PubMed  Google Scholar 

  6. Behairy YM, Al-Sebai W (2001) A modified technique for harvesting full-thickness iliac crest bone graft. Spine 26(6): 695–697

    Article  PubMed  Google Scholar 

  7. Bezer M, Kocaoglu B, Aydin N, Guven O (2004) Comparison of traditional and intrafascial iliac crest bone-graft harvesting in lumbar spinal surgery. Int Orthop 28(6): 325–328

    PubMed  Google Scholar 

  8. Burkus JK, Heim SE, Gornet MF, Zdeblick TA (2004) The effectiveness of rhBMP-2 in replacing autograft: an integrated analysis of three human spine studies. Orthopedics 27(7): 723–728

    PubMed  Google Scholar 

  9. Burstein FD, Simms C, Cohen SR, Work F, Paschal M (2000) Iliac crest bone graft harvesting techniques: a comparison. Plast Reconstr Surg 105(1): 34–39

    PubMed  Google Scholar 

  10. Buttermann GR, Glazer PA, Hu SS, Bradford DS (1997) Revision of failed lumbar fusions. A comparison of anterior autograft and allograft. Spine 22(23): 2748–2755

    Article  PubMed  Google Scholar 

  11. Cammisa FP Jr, Lowery G, Garfin SR et al. (2004) Two-year fusion rate equivalency between Grafton DBM gel and autograft in posterolateral spine fusion: a prospective controlled trial employing a side-by-side comparison in the same patient. Spine 29(6): 660–666

    Article  PubMed  Google Scholar 

  12. Challis JH, Lyttle JA, Stuart AE (1975) Strangulated lumbar hernia and volvulus following removal of iliac crest bone graft. Acta Orthop Scand 46(2): 230–233

    PubMed  Google Scholar 

  13. Chan K, Resnick D, Pathria M, Jacobson J (2001) Pelvic instability after bone graft harvesting from posterior iliac crest: report of nine patients. Skeletal Radiol 30(5): 278–281

    Article  PubMed  Google Scholar 

  14. Cheung KM, Zhang YG, Lu DS, Luk KD, Leong JC (2003) Reduction of disc space distraction after anterior lumbar interbody fusion with autologous iliac crest graft. Spine 28(13): 1385–1389

    Article  PubMed  Google Scholar 

  15. Cobden RH, Thrasher EL, Harris WH (1976) Topical hemostatic agents to reduce bleeding from cancellous bone. A comparison of microcrystalline collagen, thrombin, and thrombin-soaked gelatin foam. J Bone Joint Surg Am 58(1): 70–73

    PubMed  Google Scholar 

  16. Chou D, Storm PB, Campbell JN (2004) Vulnerability of the subcostal nerve to injury during bone graft harvesting from the iliac crest. J Neurosurg Spine 1(1): 87–89

    PubMed  Google Scholar 

  17. Coventry MB, Tapper EM (1972) Pelvic instability: a consequence of removing iliac bone for grafting. J Bone Joint Surg Am 54(1): 83–101

    PubMed  Google Scholar 

  18. Cowan N, Young J, Murphy D, Bladen C (2002) Double-blind, randomized, controlled trial of local anesthetic use for iliac crest donor site pain. J Neurosci Nurs 34(4): 205–210

    PubMed  Google Scholar 

  19. Cowley SP, Anderson LD (1983) Hernias through donor sites for iliac-bone grafts. J Bone Joint Surg Am 65(7): 1023–1025

    PubMed  Google Scholar 

  20. Cricchio G, Lundgren S (2003) Donor site morbidity in two different approaches to anterior iliac crest bone harvesting. Clin Implant Dent Relat Res 5(3): 161–169

    PubMed  Google Scholar 

  21. David R, Folman Y, Pikarsky I, Leitner Y, Catz A, Gepstein R (2003) Harvesting bone graft from the posterior iliac crest by less traumatic, midline approach. J Spinal Disord Tech 16(1): 27–30

    PubMed  Google Scholar 

  22. Ebraheim NA, Yang H, Lu J, Biyani A, Yeasting RA (1997) Anterior iliac crest bone graft. Anatomic considerations. Spine 22(8): 847–849

    Article  PubMed  Google Scholar 

  23. Escalas F, DeWald RL (1977) Combined traumatic arteriovenous fistula and ureteral injury: a complication of iliac bone-grafting. J Bone Joint Surg Am 59(2): 270–271

    PubMed  Google Scholar 

  24. Eufinger H, Leppanen H (2000) Iliac crest donor site morbidity following open and closed methods of bone harvest for alveolar cleft osteoplasty. J Craniomaxillofac Surg 28(1): 31–38

    PubMed  Google Scholar 

  25. Friedenstein AJ (1973) Determined and inducible osteogenic precursor cells. In: Elliott K, Fitzsimons D (eds) Hard tissue growth, repair and mineralisation. 11th Ciba Foundation Symposium. Elsevier, Amsterdamm, pp 169–185

  26. Gamradt SC, Lieberman JR (2004) Genetic modification of stem cells to enhance bone repair. Ann Biomed Eng 32(1): 136–147

    Article  PubMed  Google Scholar 

  27. Geideman W, Early JS, Brodsky J (2004) Clinical results of harvesting autogenous cancellous graft from the ipsilateral proximal tibia for use in foot and ankle surgery. Foot Ankle Int 25(7): 451–455

    PubMed  Google Scholar 

  28. Girardi FP, Cammisa FP Jr (2003) The effect of bone graft extenders to enhance the performance of iliac crest bone grafts in instrumented lumbar spine fusion. Orthopedics 26 [Suppl 5]: 545–548

  29. Goulet JA, Senunas LE, DeSilva GL, Greenfield ML (1997) Autogenous iliac crest bone graft. Complications and functional assessment. Clin Orthop 339: 6-81

    Google Scholar 

  30. Gundes H, Kilickan L, Gurkan Y, Sarlak A, Toker K (2000) Short- and long-term effects of regional application of morphine and bupivacaine on the iliac crest donor site. Acta Orthop Belg 66(4): 341–344

    PubMed  Google Scholar 

  31. Haid RW Jr, Branch CL Jr, Alexander JT, Burkus JK (2004) Posterior lumbar interbody fusion using recombinant human bone morphogenetic protein type 2 with cylindrical interbody cages. Spine J 4(5): 527–538

    Article  PubMed  Google Scholar 

  32. Harris MB, Davis J, Gertzbein SD (1994) Iliac crest reconstruction after tricortical graft harvesting. J Spinal Disord 7(3): 216–221

    PubMed  Google Scholar 

  33. Heary RF, Schlenk RP, Sacchieri TA, Barone D, Brotea C (2002) Persistent iliac crest donor site pain: independent outcome assessment. Neurosurgery 50(3): 510–516

    Article  PubMed  Google Scholar 

  34. Horwitz EM, Gordon PL, Koo WK et al. (2002) Isolated allogeneic bone marrow-derived mesenchymal cells engraft and stimulate growth in children with osteogenesis imperfecta: Implications for cell therapy of bone. Proc Natl Acad Sci USA 99(13): 8932–8937

    Article  PubMed  Google Scholar 

  35. Hutchinson MR, Dall BE (1994) Midline fascial splitting approach to the iliac crest for bone graft. A new approach. Spine 19(1): 62–66

    PubMed  Google Scholar 

  36. Jäger M, Wild A, Schmidt S, Krauspe R (2004) Variationen der subkutanen Verläufe von Nerven im Beckenbereich unter Berücksichtigung orthopädisch-operativer Zugangswege. Zentralbl Chir 129(5): 408–412

    Article  PubMed  Google Scholar 

  37. Jäger M, Sager M, Knipper A et al. (2004) In-vitro und in-vivo Knochenregenerierung durch mesenchymale Stammzellen aus dem Nabelschnurblut. Orthopäde 33(12): 1361–1372

    Google Scholar 

  38. Jäger M, Seller K, Raab P, Krauspe R, Wild A (2003) Clinical outcome in monosegmental fusion of degenerative lumbar instabilities: instrumented versus non-instrumented. Med Sci Monitor 9(7): 324–327

    Google Scholar 

  39. Jerosch J, Attmanspacher W (2000) Span- und Spongiosaentnahme. In: Jerosch J, Attmanspacher W (Hrsg) Standardoperationen in Orthopädie und Unfallchirurgie. Steinkopf, Darmstadt, S 97–102

  40. Joshi A, Kostakis GC (2004) An investigation of post-operative morbidity following iliac crest graft harvesting. Br Dent J 196(3): 167–171

    Article  PubMed  Google Scholar 

  41. Kahn B (1979) Superior gluteal artery laceration, a complication of iliac bone graft surgery. Clin Orthop 140: 204–207

    PubMed  Google Scholar 

  42. Kessler P, Thorwarth M, Bloch-Birkholz A, Nkenke E, Neukam FW (2005) Harvesting of bone from the iliac crest-comparison of the anterior and posterior sites. Br J Oral Maxillofac Surg 43(1): 51–56

    Article  PubMed  Google Scholar 

  43. Kitoh H, Kitakoji T, Tsuchiya H, Mitsuyama H, Nakamura H, Katoh M, Ishiguro N (2004) Transplantation of marrow-derived mesenchymal stem cells and platelet-rich plasma during distraction osteogenesis — a preliminary result of three cases. Bone 35(4): 892–898

    Article  PubMed  Google Scholar 

  44. Kurz LT, Garfin SR, Booth RE Jr (1989) Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine 14(12): 1324–1331

    PubMed  Google Scholar 

  45. Kushida T, Inaba M, Ikebukuro K et al. (2000) A new method for bone marrow cell harvesting. Stem Cells 18(6): 453–456

    Article  PubMed  Google Scholar 

  46. Lichtblau S (1962) Dislocation of the sacroiliac joint: A complication of bone grafting. J Bone Joint Surg Am 44: 193–198

    Google Scholar 

  47. Mahli A, Coskun D, Altun NS, Simsek A, Ocal E, Kostekci M (2002) Alcohol neurolysis for persistent pain caused by superior cluneal nerves injury after iliac crest bone graft harvesting in orthopedic surgery: report of four cases and review of the literature. Spine 27(22): 478–481

    Article  Google Scholar 

  48. Maves MD, Matt BH (1986) Calvarial bone grafting of facial defects. Otolaryngol Head Neck Surg 95(4): 464–470

    PubMed  Google Scholar 

  49. Meisel R, Zibert A, Laryea M, Gobel U, Daubener W, Dilloo D (2004) Human bone marrow stromal cells inhibit allogeneic T-cell responses by indoleamine 2,3-dioxygenase-mediated tryptophan degradation. Blood 103(12): 4619–4621

    Article  PubMed  Google Scholar 

  50. Miao D, Murant S, Scutt N, Genever P, Scutt A (2004) Megakaryocyte-bone marrow stromal cell aggregates demonstrate increased colony formation and alkaline phosphatase expression in vitro. Tissue Eng 10(5–6): 807–817

    Google Scholar 

  51. Mirovsky Y, Neuwirth MG (2000) Comparison between the outer table and intracortical methods of obtaining autogenous bone graft from the iliac crest. Spine 25(13): 1722–1725

    Article  PubMed  Google Scholar 

  52. Mirovsky Y, Neuwirth M (2000) Injuries to the lateral femoral cutaneous nerve during spine surgery. Spine 25(10): 1266–1269

    Article  PubMed  Google Scholar 

  53. Muschler GF, Boehm C, Easley K (1997) Aspiration to obtain osteoblast progenitor cells from human bone marrow: the influence of aspiration volume. J Bone Joint Surg Am 79(11): 1699–1709

    PubMed  Google Scholar 

  54. Muschler GF, Nitto H, Boehm CA, Easley KA (2001) Age- and gender-related changes in the cellularity of human bone marrow and the prevalence of osteoblastic progenitors. J Orthop Res 19(1): 117–125

    Article  PubMed  Google Scholar 

  55. Niedhart C, Pingsmann A, Jürgens C, Marr A, Blatt R, Niethard FU (2003) Komplikationen nach Entnahme autologen Knochens aus dem ventralen und dorsalen Beckenkamm — eine prospektive, kontrollierte Studie. Z Orthop 141(4): 481–486

    Article  PubMed  Google Scholar 

  56. Nkenke E, Weisbach V, Winckler E, Kessler P, Schultze-Mosgau S, Wiltfang J, Neukam FW (2004) Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic augmentation procedures: a prospective study. Int J Oral Maxillofac Surg 33(2): 157–163

    Article  PubMed  Google Scholar 

  57. Pitzen T, Kranzlein K, Steudel WI, Strowitzki M (2004) Postoperative Beschwerden und Befunde im Bereich der Spanentnahme am Becken bei ventraler zervikaler Fusion. Zentralbl Neurochir 65(1): 7–12

    Article  PubMed  Google Scholar 

  58. Nocini PF, Bedogni A, Valsecchi S, Trevisiol L, Ferrari F, Fior A, Saia G (2003) Fractures of the iliac crest following anterior and posterior bone graft harvesting. Review of the literature and case presentation. Minerva Stomatol 52(10): 441–452

    Google Scholar 

  59. Porchet F, Jaques B (1986) Unusual complications at iliac crest bone graft donor site: experience with two cases. Neurosurgery 39(4): 856–659

    Google Scholar 

  60. Price CT, Connolly JF, Carantzas AC, Ilyas I (2003) Comparison of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis. Spine 28(8): 793–798

    Article  PubMed  Google Scholar 

  61. Rish BL, McFadden JT, Penix JO (1976) Anterior cervical fusion using homologous bone grafts: a comparative study. Surg Neurol 5(2): 119–121

    PubMed  Google Scholar 

  62. Robertson PA, Wray AC (2001) Natural history of posterior iliac crest bone graft donation for spinal surgery: a prospective analysis of morbidity. Spine 26(13): 1473–1476

    Article  PubMed  Google Scholar 

  63. Rossillon R, Desmette D, Rombouts JJ (1999) Growth disturbance of the ilium after splitting the iliac apophysis and iliac crest bone harvesting in children: a retrospective study at the end of growth following unilateral Salter innominate osteotomy in 21 children. Acta Orthop Belg 65(3): 295–301

    PubMed  Google Scholar 

  64. Samartzis D, Shen FH, Matthews DK, Yoon ST, Goldberg EJ, An HS (2003) Comparison of allograft to autograft in multilevel anterior cervical discectomy and fusion with rigid plate fixation. Spine J 3(6): 451–459

    Article  PubMed  Google Scholar 

  65. Sandor GK, Rittenberg BN, Clokie CM, Caminiti MF (2003) Clinical success in harvesting autogenous bone using a minimally invasive trephine. J Oral Maxillofac Surg 61(2): 164–168

    Article  PubMed  Google Scholar 

  66. Sarwat AM, O’Brien JP, Renton P, Sutcliffe JC (2001) The use of allograft (and avoidance of autograft) in anterior lumbar interbody fusion: a critical analysis. Eur Spine J 10(3): 237–241

    Article  PubMed  Google Scholar 

  67. Savolainen S, Usenius JP, Hernesniemi J (1994) Iliac crest versus artificial bone grafts in 250 cervical fusions. Acta Neurochir (Wien) 129(1–2): 54–57

    Google Scholar 

  68. Schaan M, Schmitt N, Boszczyk B, Jaksche H (2004) Reduction in late postoperative pain after iliac crest bonegraft harvesting for cervical fusion: a controlled double-blinded study of 100 patients. Acta Neurochir (Wien) 146(9): 961–965

    Article  Google Scholar 

  69. Schnee CL, Freese A, Weil RJ, Marcotte PJ (1997) Analysis of harvest morbidity and radiographic outcome using autograft for anterior cervical fusion. Spine 22(19): 2222–2227

    Article  PubMed  Google Scholar 

  70. Skaggs DL, Samuelson MA, Hale JM, Kay RM, Tolo VT (2000) Complications of posterior iliac crest bone grafting in spine surgery in children. Spine 25(18): 2400–2402

    Article  PubMed  Google Scholar 

  71. Strating RP, Schenk KE, Raaymakers EL (1991) Cicatricial hernia after bone grafting from the iliac crest. Neth J Surg 43(2): 41–42

    PubMed  Google Scholar 

  72. Summers BN, Eisenstein SM (1989) Donor site pain from the ilium. A complication of lumbar spine fusion. J Bone Joint Surg Br 71(4): 677–680

    PubMed  Google Scholar 

  73. Tomford WW (2001) Bone allografts: past, present and future. Cell Tissue Bank 1(2): 105–109

    Article  Google Scholar 

  74. Wang MY, Levi AD, Shah S, Green BA (2002) Polylactic acid mesh reconstruction of the anterior iliac crest after bone harvesting reduces early postoperative pain after anterior cervical fusion surgery. Neurosurgery 51(2): 413–416

    Article  PubMed  Google Scholar 

  75. Westrich GH, Geller DS, O’Malley MJ, Deland JT, Helfet DL (2001) Anterior iliac crest bone graft harvesting using the corticocancellous reamer system. J Orthop Trauma 15(7): 500–506

    Article  PubMed  Google Scholar 

  76. Wilson PA (1995) Pain relief following iliac crest bone harvesting. Br J Oral Maxillofac Surg 33(4): 242–243

    Article  PubMed  Google Scholar 

  77. Windhagen H, Witte F, Thorey F, Hurschler C, Wirth CJ (2004) Injizierbare Trägersysteme für die Wachstumsfaktorapplikation zur minimal-invasiven Knochenheilungsstimulation. Orthopäde 33(12): 1378–1385

    Google Scholar 

  78. Wolfe SA, Kawamoto HK (1978) Taking the iliac-bone graft. J Bone Joint Surg Am 60(3): 411

    PubMed  Google Scholar 

  79. Zijderveld SA, ten Bruggenkate CM, van Den Bergh JP, Schulten EA (2004) Fractures of the iliac crest after split-thickness bone grafting for preprosthetic surgery: report of 3 cases and review of the literature. J Oral Maxillofac Surg 62(7): 781–786

    Article  PubMed  Google Scholar 

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  1. Orthopädische Klinik, Heinrich-Heine-Universität, Düsseldorf

    M. Jäger, B. Westhoff &  R. Krauspe

  2. Orthopädische Klinik, Universität Leipzig

    A. Wild

  3. Orthopädische Klinik, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf

    R. Krauspe

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  1. M. Jäger
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  4. R. Krauspe
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Correspondence to R. Krauspe.

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Jäger, M., Westhoff, B., Wild, A. et al. Knochenspanentnahme am Becken. Orthopäde 34, 976–994 (2005). https://doi.org/10.1007/s00132-005-0839-0

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