带血管蒂桡骨瓣移植联合舟头固定治疗Lichtman Ⅱ、ⅢA期月骨无菌性坏死的早期疗效  

The fourth to fifth extensor compartmental artery vascularized bone graft combined with scaphocapitate fixation for the treatment of Lichtman Ⅱ and ⅢA Kienbock disease

作　　者：孟冲[1] 王宁宁[1] 赵上坤 刘鸿浩 吴学建[1] Meng Chong;Wang Ningning;Zhao Shangkun;Liu Honghao;Wu Xuejian(Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,郑州450052

出　　处：《中华手外科杂志》2023年第4期358-361,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨第4、5间室内动脉蒂桡骨瓣移植联合舟头固定治疗Lichtman Ⅱ、ⅢA期月骨无菌性坏死的临床疗效。方法自2018年2月至2020年3月,我们对9例Lichtman Ⅱ、ⅢA期月骨无菌性坏死患者,采用第4、5间室内动脉蒂桡骨瓣移植联合舟头固定的方法治疗。分别于术前、术后3个月、术后6个月时随访患者腕关节运动范围(range of motion,ROM)和患侧健侧握力比值,以及疼痛视觉模拟评分(visual analogue scale,VAS)、腕关节PRWE评分。根据腕部X线片测量腕高比,根据腕关节MRI观察月骨高信号与月骨面积比值。结果术后9例患者均获得随访。术前VAS平均(6.22±1.39)分,术后3个月为(1.44±0.88)分,差异有统计学意义(P<0.05)。术前患侧健侧手握力比值为0.47±0.09,术后3个月为0.81±0.06,差异有统计学意义(P<0.05)。术前腕关节ROM为(84.55±4.24)°,术后6个月为(89.88±3.75)°,差异无统计学意义(P>0.05)。腕关节PRWE评分术前为73.22±7.37,术后3个月为34.67±10.98,差异有统计学意义(P<0.05)。术前腕高比为0.53±0.01,术后3个月为0.52±0.02,差异无统计学意义(P>0.05)。术前MRI月骨高信号面积与月骨面积比值为0.94±0.06,术后6个月为0.96±0.04,差异无统计学意义(P>0.05)。结论第4、5间室内动脉蒂桡骨瓣移植联合舟头固定治疗Lichtman Ⅱ、ⅢA期月骨无菌性坏死,早期可以良好地缓解疼痛,改善腕关节功能。Objective To report the outcome of the fourth to fifth extensor compartmental artery vascularized bone graft combined with scaphocapitate fixation for the treatment of LichtmanⅡandⅢA Kienbock disease.Methods From February 2018 to March 2020,9 patients with LichtmanⅡandⅢA Kienbock disease were treated with the fourth to fifth extensor compartmental artery vascularized bone graft combined with scaphocapitate fixation.The patients′wrist range of motion(ROM),grip strength ratio of affected side to contralateral side,visual analogue scale(VAS)of pain and wrist PRWE score were followed up before operation and 3 or 6 months after operation.The wrist height ratio was measured based on wrist X-ray film,and the ratio of lunar bone height signal to lunar bone area was observed based on wrist joint MRI.Results All the 9 patients obtained follow-up.The average VAS was 6.22±1.39 before operation and 1.44±0.88 at 3 months after operation.The difference was statistically significant(P<0.05).The ratio of grip strength of affected side to contralateral side was 0.47±0.09 before operation and 0.81±0.06 at 3 months after operation.The difference was statistically significant(P<0.05).The ROM of wrist was(84.55±4.24)°before operation and(89.88±3.75)°at 6 months after operation.There was no significant difference(P>0.05).The PRWE score was 73.22±7.37 before operation and 34.67±10.98 at 3 months after operation.The difference was statistically significant(P<0.05).The wrist height ration was 0.53±0.01 before operation and 0.52±0.02 at 3 months after operation.The ratio of high signal area to lunate bone area in MRI was 0.94±0.06 before operation and 0.96±0.04 at 6 months after operation.There was no significant difference(P>0.05).Conclusion The fourth to fifth extensor compartmental artery vascularized bone graft combined with scaphocapitate fixation for the treatment of patients with LichtmanⅡandⅢA Kienbock disease can effectively alleviate pain and improve wrist joint function.

关 键 词：月骨 Kienbock病 骨瓣移植 舟头固定 

分 类 号：R687.3[医药卫生—骨科学]