第一、二伸肌室间支持带上动脉为血管蒂的楔形骨瓣转移治疗舟骨骨不连

目的 探讨以第1,2伸肌室间支持带上动脉(1,2 ICSRA)为血管蒂的楔形骨瓣转移治疗舟骨骨不连伴背侧镶嵌不稳定(DISI)的技术和疗效.方法 对12例舟骨骨不连伴背侧镶嵌不稳定的患者,设计并应用1,2 ICSRA为血管蒂的楔形骨瓣进行治疗,采用腕背侧单一切口同时完成畸形矫正和骨瓣转移.术后随访骨折愈合时间、腕痛状况,比较手术前后腕关节活动度、握力、腕骨排列情况.结果 术后随访时间为6～24个月,平均12个月.X线片显示舟骨骨折均获得骨性愈合,愈合率为100%,平均愈合时间为11.3周.11例患者腕痛消失;1例腕痛持续,经行桡骨茎突切除后好转.12例术后头月骨间角、舟月骨间角、腕高指数恢复正常;腕关节屈伸、桡尺偏活动度接近术前的2倍,握力为术前的3.5倍.结论 1,2 ICSRA为血管蒂的楔形骨瓣转移能促进舟骨愈合,矫正骨折成角,有利于腕部生理力学的重建,是治疗舟骨骨不连伴DISI的有效方法.

Transfer of vascularized bone graft based on the 1,2 intercompartmental supraretinacular artery for treatment of scaphoid nonunion associated with dorsal intercalated segment instability

Objective To investigate the operative technique and clinical outcome of using vascularized bone graft based on the 1,2 intercompartmental suprarefinacular artery(1,2 ICSRA)for treatment of scaphoid nonunion associated with dorsal intemalated segment instability(DISI).Methods Twelve cases of scaphoid nonunion associated with DISI were involved in his study.We corrected DISI deformity and performed the vascularized bone graft within a single curvilinear dorsal radial incision.Time for fracture union and resolution of wrist pain was evaluated.Wrist motion,grip strength and carpal alignment were measured and compared.Results Postoperative follow up ranged from 6 to 24 months,with an average of 12 months.Bone union was achieyed in all the cases with a mean time of 11.3 weeks.Wrist pain disappeared in 11 cases.Persistent wrist pain in 1 case was resolved by resection of the radial styloid.Scapholunate angle,capitolunate ansle and carpal hdght index were restored postoperatively in all 12 cases.Range of flexion-extension and ulnar-radial deviafion intuited two folds comparing to the preoperative values.Grip strength was 3.5 times higher than that of the preoperative one.Conclusion 1,2 ICSRA pedicled bone graft can lead to good bone healing and correction of malformation of the seaphoid fracture,which is essential for restoration of normal wrist mechanics.It is a surgery of choice for treatment of scaphoid nonunion associated with DISI.