| Summary: | 碩士 === 中國醫藥學院 === 醫學研究所 === 90 === Purpose:
The use of cancellous bone from the proximal tibia for long bone reconstruction has been documented for decades by orthopedic surgeons. However, there was less than 10 years for the first clinical report of this application in jaw bone defect reconstruction. Through the years, a few modifications have been made by our group. It is our purpose to present a series of jaw bone reconstruction with this new technique.
Material & Methods:
During a period of more than 3.5 years, from March, 1998 to November, 2001, 31 consecutive tibial bone grafts were procured from a group of 30 patients (ASA: Class-I ~II) with jaw bone defects resulted from trauma, infection, tumor ablation, or physiological resorption of the edentulous area. The age distribution was 18 ~ 55 y/o. Preoperative knee joint radiographs (PA, Lat) were reviewed to exclude patients with history of knee joint problems. A modified, simple, predictable orthopedic approach was used at the donor site. Postoperative morbidity, complications, procuring time, and available donor bone volume were well documented.
Results:
The overall postoperative morbidity and complication rate was minimal on both donor and recipient sites. The average pre-condensed donor bone volume was about 16.3 ml, ranging from 12 to 32 ml. The procuring time from the proximal tibia ( < 60 minutes) was significantly less than that from the ilium. All patients could commence load bearing on the lower extremities and walk without a cane within 24 hours postoperatively.
Discussion:
With the modified incision technique, good quality and large amount of cancellous bone graft can be obtained from the proximal tibia leaving almost invisible suture mark, about 2~3 cm long at the anterio-lateral aspect of lower leg. Wound closure at the tenden-periosteal layer becomes easier with less severity of post-operative morbidity. However, due to the relatively low compressive strength of the particulate cancellous bone, it is limited to graft within the space filling defects. Although reentry to the same tibia is not advocated in the literatures, it may still be possible to explore the same donor site as long as the cancellous bone volume of the 1st procurement was minimum. The way of measuring the procured bone volume is also much more practical and reliable.
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