游离膝降血管蒂骨瓣移植治疗舟骨骨不连

目的 观察游离膝降血管蒂骨瓣移植对舟骨骨折不连接的治疗作用.方法 2007年1月至2009年8月,对6例舟骨骨不连,应用游离膝降血管蒂骨瓣移植治疗.疗效的评定包括骨折愈合、疼痛、握力和腕关节活动度,运用改良Mayo腕关节评分对患者的自觉功能恢复情况进行评定,术后舟骨的血供采用彩色多普勒超声检查.结果 术后随访时间平均为18个月,6例舟骨骨不连均愈合,平均时间为12周(11 ～ 16周)；采用视觉模拟评分法,平均评分为1.0(0～2.2)；术后握力平均恢复至健侧的85％；腕关节活动度:屈伸(115±10)°,尺桡偏(54±14)°；腕关节评分:优4例,良1例,可1例.彩色多普勒超声证实舟骨血供良好.结论 游离膝降血管蒂骨瓣移植是治疗植骨失败或伴近极缺血坏死的舟骨骨不连的有效方法.

Free bone flap transplantation with descending genicular vessels for treatment of scaphoid nonunion

Objective To evaluate the effect of bone flap transplantation with descending genicular vessels for treatment of scaphoid nonunion.Methods From January 2007 to August 2009,6 cases of scaphoid nonunion were treated with free bone flap transplantation with descending genicular vessels.The results of the procedure were assessed in terms of osseous union,pain,grip strength and active motion of the wrist.Postoperatively treatment outcomes were evaluated by the Mayo modified wrist score system based on patients' perception of function,while vascularity of the scaphoid was evaluated by using color Doppler ultrasonography.Results Postoperative follow-up averaged 18 months.Scaphoid union occurred in all cases at an average of 12 weeks (range,11 to 16 weeks).The average pain score for these 6 patients was 1.0 points (range,0 to 2.2points) on the visual analog scale.The postoperative grip strength was 85％ of the contralateral side.The range of motion of the wrist was:flexion-extension ( 115 ± 10)°,radioulnar deviation (54 ± 14)°.An excellent outcome in the wrist function was found in 4 patients,a good outcome in 1 patient,fair in 1 patient.Vascularity of the scaphoid was good as confirmed by color Doppler ultrasonography. Conclusion Transplantation of bone flap with descending genicular vessels is an effective method for the treatment of scaphoid nonunion with avascular necrosis of the proximal fragment or with previously failed conventional bone grafting.