游离股骨内侧髁骨瓣移植治疗手舟骨陈旧性骨折伴骨坏死  

Free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis

作　　者：赵志明[1] 邢丹谋[1] 任东[1] 陈焱[1] 冯伟[1] 肖志宏[1] 王欢[1] Zhao Zhiming;Xing Danmou;Ren Dong;Chen Yan;Feng Wei;Xiao Zhihong;Wang Huan(Departmeng of Hand Surgery, Puai Hospital Affiliated to Ton~i Medical College of Huazhong University of Science and Technology, Orthopedic Hospital of Wuhan, Wuhan 430000,Chin)

机构地区：[1]华中科技大学同济医学院附属普爱医院,武汉市骨科医院手外科,武汉430000

出　　处：《中华显微外科杂志》2018年第2期133-136,共4页Chinese Journal of Microsurgery

摘　　要：目的评估股骨内侧髁游离骨瓣移植治疗手舟骨陈旧性骨折伴骨坏死的疗效及应用价值。方法自2013年2月至2015年5月．采用以膝降动脉为蒂的股骨内侧髁骨瓣游离移植治疗手舟骨陈旧性骨折伴骨坏死11例．男9例，女2例：年龄27。55岁，平均34岁。左侧6例，右侧5例；近极骨折6例，腰部骨折5例。术前常规行CT检查。证实舟骨骨折不愈合伴骨硬化坏死，伴驼背畸形6例，伴近极坏死3例，伴腕部疼痛9例，按改良Mavo评分法功能评定均为差。术中清除骨折断端坏死骨组织，将骨瓣游离移植于骨缺损处，复位后以多枚克氏针固定．骨瓣动脉与桡动脉端侧吻合，伴行静脉与桡动脉伴行静脉端端吻合。术后行石膏托固定，伤口2周拆线．改为对掌位管型石膏固定6周，根据X线及三维CT判断骨折愈合情况。术后随访观察骨折愈合情况，术后半年起采用改良Mayo法评估腕关节功能。结果所有患者均获得随访，平均13．1个月（9-24个月）。11例患者2周时伤口均愈合良好．无感染、受区神经损伤等并发症．供区血肿1例，膝关节前区麻木3例。骨折均达到骨性愈合．愈合时间平均13．4周（11-18周）。腕关节功能评价：优5例，良4例，可2例。其中合并供区血肿1例．腕关节功能活动受限伴腕部疼痛2例。结论游离股骨内侧髁骨瓣血管变异少，切取难度低，骨量充足，供区损伤小．对于手舟骨陈旧性骨折伴有骨坏死的病例．清除死骨后常常出现较大的骨缺损，采用游离股骨内侧髁骨瓣移植．愈合效果好．是一个较好的手术方式。Objective To evaluate the outcomes of the free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis and review the utility of this procedure. Methods Eleven cases of old scaphoid fracture with bone necrosis were treated with the free medical femoral condyle bone grafting between Febu- ray, 2013 and May, 2015（9 males and 2 females）. The average age was 34 years ranged from 27 to 55 years. Six cas- es were in left wrist, and other 5 cases were in right. Six cases were in waist area, and the other 5 cases were proximal pole nonunion. All cases were evaluated with 3D-CT scan, while humpback deformity were occurred in 6 cases, and avascular necrosis at the proximal pole were occurred in 3 cases. After refreshing the fracture, the free medical femoral condyle bone was transferred to the scaphoid, reduct the scaphoid and fix with the Kirschner wire. An end- to-side anastomosis was performed with the bone flap artery and the radial artery, accompanied by the end to end anastomosis of the flap vein and the vein with the radial artery. The plaster was used for 8 weeks. Bone healing was evaluated with X-ray and 3D CT scan. A functional review was performed after the operation and a Mayo wrist scoring test was taken 6 months after the treatment. Results The average followed-up period was 13.1 months（ranged from 9 to 24 months）. Bone union were demonstrated in all cases at 13.4 weeks after the operation （ranged from 11 to 18 weeks）. Mayo wrist scoring testing showed excellent in 5 cases, good in 4 cases, and fair in 2 cases. Conclusion Free bone flap of medial femoral condyle is constant in vascular anatomy, and is easy to perform with plenty bone graft and less morbidity at donor site. Medial femoral condyle bone flap transplantation based on the descending gen- nicular vessels is an effective method for treatment of old scaphoid fracture with bone necrosis.

关 键 词：手舟骨 陈旧性骨折 膝降动脉 股骨内侧髁骨瓣 

分 类 号：R658.2[医药卫生—外科学]