游离股骨内侧髁骨瓣移植治疗掌指骨骨折不愈合  

Free bone flap of medial femoral condyle for treatment of refractory hand nonunion

作　　者：任东[1] 邢丹谋[1] 冯伟[1] 陈焱[1] 赵志明[1] 肖志宏[1] 彭正人[1] 

机构地区：[1]武汉市普爱医院武汉市骨科医院手外科,430033

出　　处：《中华手外科杂志》2015年第6期442-444,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨膝降动脉为蒂的游离骨瓣移植在治疗掌指骨骨折不愈合中的应用价值。方法白2012年10月至2014年4月，我们采用以膝降动脉为蒂的股骨内侧髁骨瓣游离移植治疗掌指骨骨折不愈合6例，其中掌骨2例，近节指骨3例，中节指骨1例。术中清创骨折端，随后将骨瓣移至缺损处，骨瓣动脉与指总动脉端端吻合，伴行静脉与皮下浅静脉端端吻合。术后石膏托固定4—6周，根据X线片判断骨折愈合情况。结果6例患者均获得随访，时间为6—11个月，平均8．5个月；骨折均愈合，愈合时间为9～16周，平均11．5周。结论游离股骨内侧髁骨瓣血管恒定，解剖简单。血管直径与指总动脉匹配，供区骨质好，骨量充足，损伤小，且部位较隐蔽。该方法是治疗掌指骨骨折不愈合的一种有效方式。Objective To evaluate the value of free transplantation of a bone flap based on the descending genicular artery in the treatment of nonunion of metacarpal or phalangeaf fractures. Methods From October 2012 to April 2014, 6 cases of fracture nonunion in the hand were treated with free transplantation of a bone flap from the medial femoral condyle based on the descending genicular vessels. There were 2 metacarpal fractures, 3 proximal phalangeal fractures and 1 middle phalangeal fracture. After freshening of the bone ends, the vascularized bone graft was inserted at the bone defect site. The descending genicular artery and its vena comhans were anastomosed to the common digital artery and the superficial vein, respectively, in an end-to-end fashion. The wrist and finger joints were immobilized postoperatively within a plaster cast for 4 to 6 weeks. Bone healing was evaluated with X-rays. Results The average follow-up period was 8.5 months （range, 6 to 11 months）. Bone union was achieved in all patients at an average of 11.5 weeks after the surgery, ranging from 9 to 16 weeks. Conclusion Transplantation of a medial femoral condyle bone flap based on the descending genicular vessels is an effective method for treatment of fracture nonunion in the hand. The vascular anatomy is constant. Flap harvest is simple. There is a good match in the vessel diameters. In addition, the donor site is hidden with plenty of bone and good bone conditions.

关 键 词：手损伤 骨折 不愈合 膝降动脉 

分 类 号：R683.42[医药卫生—骨科学]