桡动脉茎突返支骨瓣移植联合空心钉内固定治疗腕舟骨骨不连  

Transplantation of radial artery pedicle backflow branch bone flap and internal fixation with hollow nail for the treatment of scaphoid old fracture non-union

作　　者：史卫东 吴卓 韩力 赵建文 Shi Weidong;Wu Zhuo;Han Li;Zhao Jianwen(Department of Microsurgery,The Fourth Medical Center of Chinese PLA General Hospital,Beijing,100142,China)

机构地区：[1]解放军总医院第四医学中心显微外科,北京100142

出　　处：《生物骨科材料与临床研究》2024年第6期17-20,26,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨桡动脉茎突返支骨瓣移植联合空心钉内固定治疗腕舟骨骨不连的有效性及临床效果。方法回顾性分析2020年2月至2023年1月于解放军总医院第四医学中心接受桡骨远端骨瓣治疗腕舟骨陈旧性骨折骨不连的12例患者资料。患者均采用桡动脉茎突返支骨瓣移植、空心钉内固定治疗腕舟骨骨折不愈合。经过在最终随访时间的临床查体[掌屈、背伸、尺偏和桡偏的运动范围,Mayo腕关节评分,肩部和手部功能障碍(disabilities of the arm,shoulder and hand,DASH)评分,手部握力]与DR影像检查,并记录骨折愈合时间,评价最终治疗效果。结果12例腕舟骨骨折骨不连患者随访时间为13~30个月,平均为(21.75±4.61)个月。术后的平均愈合时间为(12.16±2.95)周,腕关节、手部功能恢复良好,影像学检查示患者桡月角及舟月角得到有效改善,与术前比较差异有统计学意义(P<0.05)。结论采用桡动脉茎突返支骨瓣移植联合空心钉内固定是治疗舟骨陈旧性骨折骨不连的一种有效方式,患者术后能够获得良好的骨折愈合与腕关节、手部功能。Objective To further explore effective and ideal treatment options for scaphoid nonunion.Methods We retrospectively studied 12 patients from February 2020 to January 2023 who underwent radial bone distal flaps for the treatment of scaphoid nonunion fractures in the Fourth Medical Center of Chinese PLA General Hospital,aiming to provide new theoretical basis and treatment ideas for the clinical treatment of scaphoid nonunion.In this study,radial artery pedicle reverse branch bone flap transplantation and hollow nail internal fixation were used to treat 12 cases of scaphoid fracture nonunion at the wrist joint.The final treatment effect was evaluated by clinical examination and DR imaging at the final follow-up time.Results In this study,12 patients with scaphoid fractures and nonunion were followed up for a duration of 13 to 30 months,with an average of(21.75±4.61)months.The average healing time after surgery for the 12 patients in this study was(12.16±2.95)weeks.Patients'wrist and hand function recovered well,and imaging studies showed effective improvement in patients'radial-lunate and scaphoid-lunate angles.Conclusion The use of radial artery pedicle reverse branch bone flap transplantation and hollow nail internal fixation is an effective method of treating scaphoid non-union fractures.Patients can achieve good fracture healing and wrist joint and hand function after surgery.When deciding which surgical treatment is more appropriate for scaphoid nonunion,various factors need to be considered to achieve good treatment outcomes and wrist joint function.

关 键 词：舟骨陈旧性骨折 舟骨骨不连 桡骨茎突骨瓣 

分 类 号：R683.41[医药卫生—骨科学]