Kienbock病_培训课件.ppt

J Hand Surg Am. 1979 Jan;4(1):23-33. Blood vessel transplantation to bone. Hori Y, Tamai S, Okuda H, Sakamoto H, Takita T, Masuhara K. Abstract In dogs an artery, a vein, and a vascular bundle were transplanted into intact bone, isolated bone segments, necrotized bone, and homografts of bone. Active proliferation of new blood vessels and formation of new bone occurred in all instances where the vascular bundle was used, when the vein was implanted into the intact bone and isolated bone, and only when the artery was implanted into intact bone. As a result of these experiments, vascular bundle transplantation has been performed in patients with Kienboecks disease, and avascular necrosis of the scaphoid, the femoral head, the talus, and other conditions. PMID: 759500 [PubMed - indexed for MEDLINE] 狗 脉管束植入完整骨、游离骨、坏死骨、同种异体骨，均有新生血管张入。为Kienbock病、舟状骨缺血坏死、股骨头坏死、距骨坏死提供新的治疗方法。 可被移植的带蒂骨瓣有： 桡骨远端旋前方肌附丽点骨瓣 桡骨远端截取以第4 和第5 伸肌间室动脉为蒂的骨瓣 豌豆骨骨瓣 第2、3掌骨背侧基底部骨瓣 头状骨骨瓣 Shin 和Bishop等描述了从桡骨远端截取以第4 和第5 伸肌间室动脉为蒂的移植骨来使月骨血管重建。 采用血管化技术治疗的月骨有60% - 95% 恢复了正常结构和血液供应。这个技术对于90% 的患者可以有效缓解疼痛和改善功能。 适应症：适用于I 期至IIl A 期Kienb?ck 患者， 伴尺侧负变异， 无桡月关节或者头月关节退行性变。 头状骨短缩术 Stage I, II, or IIIA with Ulnar-Positive or Ulnar-Neutral Variance In extreme dorsiflexion, the radiolunate and lunotriquetral ligaments become tense and produce equal forces in opposite directions acting on the lunate (black arrows). The triquetrum is more likely to shift dorsally and proximally on the more compliant ulnocarpal cartilaginous complex (right arrow). Added compression from the radius (arrow A) and capitate (arrow B) results in lunate failure (see Arner and Hagberg[27]). (From Taleisnik J: The Wrist. New York, Churchill Livingstone, 1985. ? 1985, Elizabeth Roselius.) 胡桃夹效应 月骨摘除 Although several authors have reported good results after simple excision of the lunate,[59,][103,][161,][228,][391,][525] others have called this procedure a “crippling” or a “mutilating” operation[584] and a useless procedure.[59] 有作者报道单纯月骨摘除可