第4、5伸肌鞘管动脉桡骨瓣转移联合外固定架治疗月骨无菌性坏死的临床效果观察  

Clinical efficacy observation of 4+5 extensor sheath artery flap transfer combined with external fixation in treatment of aseptic necrosis of the lunate

作　　者：侯宝贤 郭宝磊[2] 宗丹[2] 关和宇[2] 潘梁[2] 王鹏[2] 裴卓斐 

机构地区：[1]吉林大学解剖教研室,长春130000 [2]沈阳市骨科医院手足显微外科,沈阳110000

出　　处：《中国当代医药》2014年第11期24-25,28,共3页China Modern Medicine

摘　　要：目的评价以第4、5伸肌鞘管动脉为蒂的桡骨远端骨瓣转移联合外固定架治疗月骨无菌性坏死的临床效果.方法对2006年6月～2013年6月诊断为月骨无菌性坏死的15例住院患者为研究对象,X线片显示月骨不同程度囊性变、密度增高或边缘硬化.采用第4、5伸肌鞘管动脉桡骨瓣联合外固定架治疗,术后10周拆除外固定架后行功能锻炼.腕关节疼痛程度采用视觉模拟评分（VAS）法评定,并对活动度进行评价,腕关节功能按Krimmer评分.结果术后随访10～18个月,平均12个月.术后腕部疼痛、无力症状较术前明显好转,术后6个月随访X线片显示月骨形态正常,坏死区消失9例,明显缩小4例,部分缩小2例,桡腕关节间隙正常.腕关节疼痛程度、活动度较术前改善,腕关节功能按Krimmer评分：优8例,良5例,可2例,优良率达86.7％.结论第4、5伸肌鞘管动脉桡骨瓣转移联合外固定架治疗月骨无菌性坏死效果确切,术后腕关节功能良好,是一种较好的治疗方法.Objective To evaluate the effectiveness of 4＋5 extensor sheath artery flap transfer combined with external fixation in treatment of aseptic necrosis of the lunate.Methods 15 cases of hospitalized patients who were diagnosed as aseptic necrosis of the lunate from June 2006 to June 2013 were selected.The patients were treated by the 4＋5 extensor sheath artery flap transfer combined with external fixation.The external fixation was removed after 10 weeks treatment, and then the patient started functional exercise.Visual analogue scale （VAS） was used to evaluate the wrist pain.Wrist motion was also evaluated.Krimmer score was used to evaluate the wrist function.Results All the patients were followed up for 10 to 18 months,average 12 months.All the patients reported an improvement in their wrist pain and weakness after surgery.X-rays taken 6 months postoperatively showed the form of lunate was normal,the necrosis area disap- peared in 9 cases,obviously narrowed in 4 cases and partially narrowed in 2 cases.The radiocarpal joint space was nor- mal.The VAS and wrist motion were improved.According to the Krimmer score,8 cases got excellent results,5 cases were good,and 2 cases were poor,the satisfactory rate was 86.7%.Conclusion 4＋5 extensor sheath artery flap transfer combined with external fixation is a reliable procedure for the treatment of aseptic necrosis of the lunate.It leads to ef- fective and satisfactory clinical results while preserving most wrist functions.

关 键 词：腕关节 月骨无菌性坏死 骨瓣移植 外固定架 

分 类 号：R687[医药卫生—骨科学]