游离带血管蒂的股骨内侧髁骨瓣治疗手舟骨骨不连的疗效分析  

Transfer of vascular pedicled free medial femoral condyle bone flap in treatment of scaphoid nonunion

作　　者：尹善青[1] 黄耀鹏[1] 周贤挺 潘佳栋[1] 李学渊[1] 王欣[1] YIN Shanqing;HUANG Yaopeng;ZHOU Xianting;PAN Jiadong;LI Xueyuan;WANG Xin(Department of Hand Surgery,Ningbo No.6 Hospital,Ningbo,Zhejiang Province 315000,China)

机构地区：[1]宁波市第六医院手外科,浙江宁波315000

出　　处：《中华显微外科杂志》2021年第3期261-266,共6页Chinese Journal of Microsurgery

基　　金：浙江省自然科学基金(LBY20H180001);宁波市自然科学基金(2018A610236);宁波市医学科技计划项目(2020Y53)。

摘　　要：目的探讨游离带血管蒂的股骨内侧髁骨瓣治疗手舟骨骨不连的临床疗效。方法自2012年5月至2016年5月,采用游离股骨内侧髁骨瓣移植治疗手舟骨骨不连15例,其中男10例、女5例,年龄18-63岁,平均(43.5±15.5)岁。术中清创骨折段后,将骨瓣移至手舟骨处充填骨缺损,将骨瓣动脉与桡动脉端侧或端端吻合,伴行静脉与桡动脉伴行静脉端端吻合,采用游离带血管蒂的股骨内侧髁骨膜瓣治疗13例,游离带血管蒂的股骨内侧髁骨软骨瓣治疗2例。术后根据X线表现评估骨折愈合情况,采用疼痛视觉模拟评分(VAS),握力及改良的Mayo腕关节评分对其临床疗效进行评价,手术前、后功能组间比较使用t检验。结果所有患者均获随访,其中门诊随访11例,微信随访4例,平均随访32.5(8-60)个月。15例患者骨折全部愈合,愈合时间平均12.5(10-16)周。术前VAS评分为(3.5±1.5)分,术后末次随访降至(1.0±1.0)分;握力由术前的(16.5±4.3)kg提高至术后末次随访的(31.5±3.5)kg;改良的Mayo腕关节评分由术前的(46.2±11.4)分提高至术后末次随访的(68.5±10.8)分,腕关节功能:优8例,良6例,可1例,手术前后功能评估差异有统计学意义(P<0.05)。结论游离股骨内侧髁骨瓣移植治疗手舟骨骨不连具有良好的功能效果。该技术为手舟骨提供了充足的血液供应及结构支持,促进了骨折的愈合,对于手舟骨近极缺血性坏死的可以采用骨软骨瓣移植替代,防止腕骨骨关节炎和塌陷,这在治疗难治性手舟骨骨不连方面有一定的优势。Objective To investigate the clinical effect of the free medial femoral condylar bone flap in treatment of scaphoid nonunion.Methods From May,2012 to May,2016,15 patients,which were 10 males and 5 females and aged from 18 to 63(mean 43.5±15.5)years,with scaphoid nonunion were treated with transfer of free medial femoral condyle bone flaps.After debridement of the fractural segment in surgery,the bone flap was transferred to scaphoid and had the bone defect filled.The artery of the bone flap was end-to-side or end-to-end anastomosed to the radial artery.The concomitant vein of the bone flap was end-to-end anastomosed to the concomitant vein of the radial artery.Thirteen patients were treated with the free osteoperiosteal medial femoral condylar graft,and 2 were treated with the free osteochondral medial femoral condylar graft.Fracture healing was evaluated based on X-ray evidence.The clinical effect was evaluated by visual analogue scale(VAS),strength of grip and modified Mayo wrist score.The t-test was used to compare the function between before and after surgery.Results All patients were entered into a followed-up for an average of 32.5(8-60)months,11 of them took the follow-up reviews at the outpatient clinic and 4 via WeChat distanced interviews.All fractures of the 15 patients healed with an average healing time at 12.5(10-16)weeks.The VAS score decreased from(3.5±1.5)before the surgery to(1.0±1.0)after the surgery.The strength of grip increased from(16.5±4.3)kg before the surgery to(31.5±3.5)kg at the last follow-up review.The modified Mayo wrist score increased from(46.2±11.4)before the surgery to(68.5±10.8)at the last follow-up review.The wrist function was excellent in 8 patients,good in 6 and fair in 1.There was significant difference in functional evaluation(P<0.05).Conclusion The transfer of free medial femoral condylar bone flap is effective in the treatment of scaphoid nonunion.This technique provides both of sufficient blood supply and a structural support for defected scaphoid bone and promo

关 键 词：手舟骨骨折 骨不连 股骨内侧髁 骨瓣 骨移植 

分 类 号：R687.3[医药卫生—骨科学]