以第一、二伸肌室间支持带上动脉为血管蒂的桡骨瓣治疗舟骨骨不连  

Vascularized distal radius graft of 1, 2 intercompartmental supraretinacular artery for scaphoid nonunion

作　　者：李京宁[1] 马振杰[1] 季远[1] 于胜军[1] 高飞[1] 毕本军[1] 

机构地区：[1]烟台市烟台山医院手外科,264001

出　　处：《中华骨科杂志》2017年第9期535-540,共6页Chinese Journal of Orthopaedics

基　　金：烟台市科学技术发展计划基金资助项目（2015WS060）

摘　　要：目的探讨掌背侧联合入路以第一、二伸肌室间支持带上动脉（the1st，2ndintercompartmentalsupraretinacu—larartery，1、2ICSRA）为血管蒂的桡骨瓣治疗舟骨骨不连的手术方法和疗效。方法回顾性分析2013年3月至2015年4月，采用掌背侧联合入路治疗16例舟骨腰部骨不连患者，男14例，女2例；年龄19-51岁，平均29．1岁；左侧6例，右侧10例；其中5例曾行石膏固定，11例伤后未行治疗；受伤距手术时间6-26个月，平均16．5个月。手术在一个切口内完成，切口的背侧部分切取以1、2ICSRA为血管蒂的桡骨瓣，切口的掌侧部分显露并清理舟骨断端、纠正舟骨畸形、掌侧楔形植骨内固定。术后随访骨折愈合时间、腕痛状况，比较手术前、后腕关节活动度及握力情况。以末次随访结果作为疗效判断结果，采用视觉模拟评分（visualanaloguescale，VAS）评估腕关节疼痛，根据改良的Mayo腕关节功能评分评价术后腕关节功能。结果术后16例患者均获得随访，随访时间6~19个月，平均11个月。所有患者x线片均显示舟骨骨不连骨性愈合，愈合率为100％；7例11周愈合，5例13周愈合，3例15周愈合，1例17周愈合，平均愈合时间12．5周。其中7例舟骨弓背畸形及背伸型不稳定均获得纠正。腕关节活动范围：屈曲平均60．2°±3．2°，背伸平均51．3°±3．5°，桡偏平均13．6°±1．42°，尺偏平均24．4°±1．8°；握力29~64kg，平均45kg。16例患者均恢复正常工作。末次随访时，14例患者腕关节活动后无疼痛，VAS评分为0分；2例腕关节活动后有轻微疼痛，VAS评分分别为0．9分和1．2分；患者腕关节功能恢复良好，Mayo腕关节功能评分69-99分，平均90．75分，其中优12例，良2例，可2例；优良率87．5％（14／16）。随访期内无一例发生感染、内固定移位、关节炎舟骨坏死等并发症。结论掌背侧联合入路以1、2ICSRA为血管�Objective To study the techniques and outcomes of using a retrograde pedicled vaseularized radius bone flap based on the 1st, 2nd intereompartmental supraretinacular artery （1, 2ICSRA） for scaphoid nonunion through dorsal and pal- mar approaches. Methods Between March 2013 and April 2015, 16 patients with scaphoid nonunion were treated by surgery through palmar and dorsal approaches. There were 14 males and 2 females with an average age of 29.1 years （range, 19-51 years）. The location of lesion was 6 cases on the left and 10 cases on the right. 5 cases were treated with plaster fixation. 11 cases weren＇ t treated after wrists injured. The preoperative time was 6-26 months, with an average of 16.5 months. The operation was completed within one incision. The bone flaps based on 1, 2ICSRA were taken through dorsal approach. The broken ends of the seaphoid frac- ture were cleaned, and the deformity was corrected with bone grafting and internal fixation through palmar approach. Time of frac- ture union and wrist pain resolution was evaluated. Wrist motion and grip strength were measured and compared. The result of the latest follow-up was used as the criterion for efficacy evaluation. The wrist pain was evaluated using visual analogue scale （VAS） and the postoperative wrist function based on the modified Mayo wrist score was recorded. Results Post-operative follow up ranged from 6-19 months, with an average of 11 months. Bone union was achieved in all the cases, so the healing rate was 100%. 7 cases were healed in 11 weeks. 5 cases were healed in 13 weeks. 3 cases were healed in 15 weeks. 1 case was healed in 17 weeks. The average healing time was 12.5 weeks. The humpback deformity of Scaphoid and DISI of 7 cases were corrected. The bending of wrist could reach 60.2°±3.2°, and the elongation could reach 51.3°± 3.5° The radial deviation of wrist could reach 13.6°±1.42°, and ulnar deviation could reach 24.4°±1.8°. The range of grip strength was 29-64 kg, with an average of 45 kg. The 16 patient

关 键 词：舟骨 骨折 不愈合 骨移植 

分 类 号：R687.3[医药卫生—骨科学]