桡动脉腕掌侧分支蒂骨瓣移位治疗腕舟骨骨不连  

Anatomic and clinical study of two vascularized radius flaps based on palmar branches of the radial artery for treatment of seaphoid nonunion

作　　者：于胜军[1] 侯忠军[1] 李京宁[1] 付胜强 孙明[1] 

机构地区：[1]烟台市烟台山医院骨科,264001

出　　处：《中华骨科杂志》2007年第6期446-450,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨桡动脉腕掌侧分支蒂骨瓣的血管解剖及其治疗腕舟骨骨不连的临床疗效。方法对20侧新鲜成人上肢标本进行显微血管解剖，观测桡动脉远段腕掌侧的骨营养分支。以桡动脉腕掌支蒂桡骨瓣（8例）和桡动脉最远端茎突支蒂桡骨茎突骨瓣（10例）治疗腕舟骨骨不连患者，男14例，女4例；年龄19-42岁，平均28．6岁。结果桡动脉远段恒定发出尺侧的腕掌支和桡侧的茎突支，血管蒂长度分别为1．28（1．10～1．40）cm和0．76（0．70-0．82）cm，起点外径分别为0．46（0．40-0．50）mm和0．28（0．26-0．32）mm，分别滋养桡骨远端尺掌侧骨膜和桡骨茎突掌侧骨膜。临床患者术后随访7-38个月。平均15个月。骨折愈合时间11-3周。腕关节活动范围：掌屈50.3°±4．0°，达健侧83．8％；背伸46．5°±5．4°，达健侧78．2％；桡偏16．9°±2．7°，达健侧75.2％；尺偏20．4°±4．0°，达健侧63．8％。1例患者腕关节在较大负重时中度疼痛。腕部握力（25．8±3．0）kg，达健侧87．9％±6．7％。X线片示1例患者发生腕骨性关节炎。Coony评分总体疗效：优15例，良2例，可1例，优良率为94．4％。结论桡动脉腕掌侧分支蒂骨瓣具有血管解剖恒定、血管蒂较长、血运丰富、手术切取方便、术后疗效好等优点，是治疗腕舟骨骨不连的理想方法。Objective To introduce the anatomic study and clinical outcomes of two vascularized radius osteal flap for treatment of scaphoid nonunion. Methods 20 fresh adult upper arms were used for microsurgical anatomic study. Two palmar branches of the distal radial artery nutritying the distal radius were emphasized. Based on anatomic investigations, 18 osteal flaps were raised in clinic, including 14 males, 4 females with the mean age of 28.6 years （ranged from 19 to 42 years）. Results Two branches originated from the distal radial artery were identified to supply the distal radius on the palmar side. One was the proximal ulnar branch with a diameter of 0.46 mm and pedicle length of 1.28 cm, run to the ulnar side. The other was the distal radial branch with a diameter of 0.28 mm and pedicle length of 0.76 cm, run to the radial styloid process. In clinic, vascularized distal radial osteol flaps were transferred in 18 cases, with the proximal ulnar branch （10 cases） and distal radial branch （8 cases） respectively. With a mean follow up 15 months, bone union occurred in 11.3 weeks. The range of motion of the wrist were palmar flexion 50.3°±4.0°, dorsal extension 46.5°±5.4°, radial deviation 16.9°±2.7°, and ulnar deviation 20.4°±4.0°. The mean grasp was （25.8±3.0） kg. There were no pain in 17 cases, and pain in weight bearing in 1 case. Outcomes measured with Coony scale were 15 excellent, 2 good, and 1 fair. Conclusion The two palmar branches originated from the distal radial artery are reliable effective vascular pedicles as distal radius osteal flap for treatment of scaphoid nonunion.

关 键 词：舟骨 骨折 不愈合 移植 自体 桡动脉 

分 类 号：R686[医药卫生—骨科学]