Scaphoid nonunion treated with vascular bone grafts pedicled on the dorsal supra-retinacular artery of the distal radius
Scaphoid nonunion treated with vascular bone grafts pedicled on the dorsal supra-retinacular artery of the distal radius
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DOI：
10.1097/01.ta.0000234723.78487.52
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发表时间：
2006-11-01
影响因子：
--
通讯作者：
Ueng, Steve Wen-Neng
中科院分区：
文献类型：
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作者：
Chen, Alvin Chao-Yu;Chao, En-Kai;Ueng, Steve Wen-Neng
背景骨不连和缺血性坏死是舟骨骨折常见的并发症。我们描述了桡骨远端带蒂血管化骨移植（VBG）治疗舟状骨骨折伴骨不连和AVN患者的手术技术和长期结果。在4年期间（1997-2000年），在我院使用以桡骨远端支持带上动脉的第一和第二或第二和第三间室为蒂的VBG治疗了11例伴有近端碎片AVN的症状性舟状骨不连患者（1例月骨周围经舟状骨骨折脱位，10例移位的舟状骨骨折伴不连）。结果：11例患者均在平均13周内获得骨性愈合，其中9例采用分叉克氏针固定，2例采用赫伯特螺钉固定。使用改良的马约腕关节评分测量的治疗功能结果在该系列中的所有患者中均令人鼓舞（4例优，6例良，1例一般）。结论：腕舟骨不连畸形得到良好矫正。索引研究表明，这种治疗不仅可以用于血运重建坏死的舟状骨，而且可以纠正驼背畸形和由此产生的腕关节不稳定。
Background. Nonunion and avascular necrosis (AVN) are frequent complications of scaphoid fractures. We describe the operative technique and long-term results of treatment with pedicle vascularized bone grafts (VBGs) of the distal radius in patients with scaphoid fractures in whom nonunion and AVN developed.Methods. During a 4-year period (1997-2000), VBGs pedicled on either the first and second or second and third compartments of the supraretinacular artery of the distal radius were in our hospital used to treat 11 patients with symptomatic scaphoid nonunion involving AVN of the proximal fragment (one with perilunate transscaphoid fracture dislocation and 10 with displaced scaphoid fractures with nonunion). Nine of these 11 patients received fixation with divergent K-wires fixation and two received Herbert screws fixation.Results: Osseous union was achieved in all 11 patients treated with VBGs within an average period of 13 weeks. Functional results of treatment, which were measured using the modified Mayo Wrist Score, were encouraging in all patients in this series (four excellent, six good, and one fair). The deformity of ununited scaphoid was well corrected.Conclusions. The index study suggests that this treatment can be used not only to revascularize necrotic scaphoid, but also to correct humpback deformity and the resulting carpal instability.