改良内固定结合带血运的桡骨茎突骨瓣植入治疗腕舟骨骨折不愈合  

Treatment of nonunion of scaphoid fracture with improved internal fixation combined with radial styloidprocess bone flap with blood supply

作　　者：吴广良[1] 张晓光[1] 马广辉 黄贺军[1] 王伟[1] 李俊明[1] Wu Guangliang;Zhang Xiaoguang;Ma Guanghui;Huang Hejun;Wang Wei;Li Junming(Department of Microsurgical Orthopedics,the Second Afiliation Hospital of Luohe Medical College,Henan 462300,China)

机构地区：[1]漯河医学高等专科学校第二附属医院显微骨科,河南462300

出　　处：《中华手外科杂志》2020年第6期419-421,共3页Chinese Journal of Hand Surgery

摘　　要：目的报告应用改良内固定方法结合带血运的桡骨茎突骨瓣植入技术治疗陈旧性腕舟骨骨折不愈合的临床效果。方法自2015年1月至2019年3月我院收治16例腕舟骨骨折不愈合患者,按照Herbert舟骨骨折不愈合分型:D1型3例,D2型8例,D3型2例,D4型3例。腕桡侧入路,切取携带桡动脉茎突返支骨膜支的楔形骨瓣,斜向去除携带约0.5 cm关节面的桡骨茎突尖部,于第一腱鞘尺侧暴露骨折端并清理硬化骨,复位骨折克氏针临时固定,腕关节屈曲位,16号斜面针头经皮插入直抵舟骨近侧极偏背侧,定位舟骨结节远侧偏背侧作出针点并用7号针头作导向,导针插入16号斜面针头内指向出针点进针,由相应出针点穿出皮肤,C臂机透视骨折及导针位置满意,拧入Herbert钉。骨折端开槽,将骨瓣植入,术后短人字石膏固定。结果术后失访3例,余13例经9个月至3年的随访,所有病例均于术后3~7个月(平均4.5个月)顺利愈合,根据Mayo腕关节功能评分评估疗效:优10例,良2例,可1例。结论通过改良内固定方法加带血管的桡骨茎突骨瓣作骨折端植骨,治疗陈旧性手舟骨骨折不愈合,降低了技术操作难度,提高了手术的精度与速度,创伤小,恢复快,疗效肯定,可重复操作性强,是治疗腕舟骨骨折不愈合的有效方法之一。Objective To report the clinical efficacy of improved internal fixation combined with radial styloid process bone flap implantation technique in the treatment of old scaphoid fracture nonunion.Methods From January 2015 to March 2019,16 cases of nonuhion of scaphoid fractures were treated in our hospital.According to Herbert's classification of nonunion of scaphoid fractures,there were 3 cases of type D1,8 cases of type D2,2 cases of type D3 and 3 cases of type D4.The wedge-shaped bone flap carrying the periosteal branch of the styloid process recurrent branch of radial artery was obtained.The apex of radial styloid process carrying about 0.5 cm articular surface was obliquely removed.The fracture end was exposed at ulnar side of the first tendon sheath and the sclerotic bone was cleaned up.The fracture was reduced and temporarily fixed with Kirschner wire.The wrist joint was in flexion position.The No.16 inclined plane needle was inserted into the dorsal side of the proximal scaphoid bone to locate the needle outlet point at the dorsal side of the distal scaphoid tubercle,and No.7 needle was used as a guide.The guide pin was inserted into the No.16 inclined plane needle,and the corresponding needle outlet point was penetrated through the skin.The fracture and the position of the guide pin were satisfactory by C-arm machine,and the Herbert nail was screwed in.The fracture end was slotted,the bone flap was implanted and fixed with short herringbone plaster.Results All the 16 cases were clinically applied,3 cases were lost to follow-up,and the remaining 13 cases were follow-up from 9 months to 3years.All the cases healed smoothly 3 to 7 months with an average of 4.5 months after operation.According to Mayo wrist function score,10 cases were excellent,2 cases were good and 1 case was fair.Conclusion Through the improved internal fixation and vascularized radial styloid process bone graft for fracture end,the oldscaphoid fracture nonunion was treated,the technical operation difficulty was reduced,the operation precisi

关 键 词：舟骨 骨折 不愈合 改良内固定 骨瓣 

分 类 号：R687.3[医药卫生—骨科学]