桡骨远端骨膜瓣移位结合Herbert螺钉内固定治疗腕舟骨骨不连

目的：探讨应用桡骨远端骨膜瓣逆行带蒂转移结合Herbert螺钉内固定治疗腕舟骨骨不连的疗效。方法回顾性分析2007年3月至2013年4月对21例腕舟骨骨不连患者采用桡骨远端骨膜瓣逆行带蒂转移结合Herbert螺钉内固定进行治疗。 X-线片显示腕舟骨腰部骨折骨不连16例，腕舟骨近端骨不连5例，切取桡骨骨膜瓣1.2cm＆#215;4.2cm。术后定期复查X-线片，随访骨折愈合时间、腕关节疼痛、腕关节活动度等情况。结果术后21例患者均获得随访，时间为8-20个月，平均10个月。骨折均达到骨性愈合，时间为3-8个月，平均为4个月，腕关节疼痛基本消失，腕关节功能参照Krimmer腕关节评分系统评定结果：优17例，良3例，可1例。结论应用带蒂桡骨远端骨膜瓣移位结合Herbert螺钉内固定治疗腕舟骨骨不连具有重建舟骨血运，促进骨折端再血管化及成骨，同时提供坚强有效内固定，提高该类骨折愈合率。

Treatment of scaphoid nonunion by stylectomy plus vascularized radial periosteum graft from the dorsal distal radius and internal fixation with Herbert screws

Objective To investigate the clinical outcome reverse-flow vascularized bone graft from the dorsal distal radius and internal fixation with Herbert screw for the treatment of scaphoid nonunion. Methods Retrospectively analyse the materials of the scaphoid nonunion in my hospital,from March 2007 to April 2013,21 cases of scaphoid nonunion were involved. Open reduc-tion,reverse-flow vascularized bone graft from the dorsal distal radius and internal fixation with Herbert screw were done. X-ray shows 16 waist fracture and nonunion,5 proximal fracture and nonunion,Cut out radial periosteum graft 1.2cm＆#215;4.2cm. Regularly review the X-ray film after operation,and follow the situations as the fracture healing time,wrist joint pain、wrist joint activity,etc. Results All 21 patients were followed up after operation ranged from 8 to 20 months （for an average 10 months）. The fractures were clinically healed ranged from 3 to 8 months （for an average 4 months）,the wrist joint pains were almost disappeared. The wrist joint functions were evaluated according to Krimmer wrist joint evaluation system：17 were rated as excellent,3 as fine,1 as middle. Conclusion The treatment of scaphoid nonunion by stylectomy plus vascularized radial periosteum graft from the dorsal distal radius and internal fixation with Herbert screws,can rebuild the scaphoid blood supply,promote fracture end vascularization and osteogenesis,meanwhile provide strong valid fixation,raise the healing rate of this fracture.