带血管蒂桡骨瓣逆行转位治疗舟骨骨不连12例  

Retrograde transposition of vascularized radial flap in the treatment of scaphoid nonunion in 12 cases

作　　者：范琛琛 叶门勒汉·巴合苏提汉 刘凯 蔡飞宇 王鑫[1] 艾合买提江·玉素甫[1] FAN Chenchen;Yemenlehan·Bahesutihan;LIU Kai(Department of Trauma and Microreconstructive Surgery,The Fist Affiliated Hospital of Xinjiang Medical University Orthopaedic Center,Urumqi,The Xinjiang Uygur Autonomous Region,830054,China)

机构地区：[1]新疆医科大学第一附属医院骨科中心显微修复外科,新疆维吾尔自治区乌鲁木齐830054

出　　处：《实用手外科杂志》2022年第2期224-226,233,共4页Journal of Practical Hand Surgery

摘　　要：目的 探讨带血管蒂桡骨瓣逆行转位治疗舟骨骨不连的疗效及可行性。方法 对2015年1月-2018年12月收治的采用由掌背侧入路内固定加带血管蒂桡骨瓣逆行转位填充治疗舟骨骨不连12例的临床资料进行回顾性分析。术后随访骨折愈合时间,并比较术前与术后腕关节疼痛、腕关节背伸活动度及握力情况。将末次随访结果作为疗效判断指标,参考视觉模拟评分(VAS)评估关节疼痛,采用改良的Mayo腕关节功能评分评估腕关节功能。结果 术后随访6~24个月,平均12个月。末次随访时,所有患者均达到骨性愈合。腕关节背伸平均52.6°±3.1°,桡偏平均12.5°±1.3°,尺偏平均23.6°±1.5°;握力30~65 kg,平均48 kg。所有患者均恢复正常工作。10例VAS评分为0分,无疼痛;2例腕关节活动时有轻微疼痛感,VAS评分分别为1分和1.2分,腕关节功能恢复均良好。Mavo腕关节功能评分65~98分,平均92分,优良率91.6%。结论 带血管蒂桡骨瓣逆行转位治疗舟骨骨不连可改善舟骨血运,促进骨折愈合,且明显改善患侧腕关节疼痛及功能,疗效肯定及可行性高。Objective To investigate the effect and feasibility of retrograde transposition of vascularized radial flap in the treatment of scaphoid nonunion. Methods From January 2015 to December 2018, 12patients with scaphoid nonunion who underwent internal fixation via dorsal metacarpal approach and retrograde transposition of vascularized radial flap were reviewed and analyzed. The fracture healing time was followed up, and the wrist pain, wrist dorsiflexion and grip strength were compared before and after operation. The last follow-up results were used as the efficacy judgment index, the last follow-up results were used as the efficacy judgment index, the joint pain was evaluated with reference to the visual analog scale(VAS), and the wrist function was evaluated with the modified Mayo wrist function score. Results The follow-up time ranged from 6 to 24 months, with an average of 12 months. At the last follow-up, all patients achieved bone healing. The average dorsal extension of wrist joint was 52.6° ±3.1°;The mean radial deviation was 12.5°±1.3°;The average ulnar deviation was 23.6°±1.5°;The grip strength was 30~65 kg, with an average of 48 kg. All patients returned to normal work. The VAS score of 11 patients was 0and there was no pain;one case had slight pain during wrist movement, and the VAS score was 1, but the wrist function recovered well. Mavo wrist function score was 65~98, with an average of 92. The excellent and good rate was 91.6%. Conclusion Retrograde transposition of vascularized radial flap in the treatment of scaphoid nonunion can improve scaphoid blood supply, promote fracture healing, and significantly improve the pain and function of the affected wrist joint. The curative effect is positive and feasible.

关 键 词：血管蒂桡骨瓣 陈旧性 腕舟骨骨不连 腕关节功能 

分 类 号：R687.3[医药卫生—骨科学]