间室伸肌支持带上动脉血管蒂骨瓣结合外固定支架治疗舟骨骨不连.DOC

1、2间室伸肌支持带上动脉外固定支架治疗舟骨 【摘要】目的 研究桡骨远端背侧带血管蒂骨瓣结合外同定支架治疗舟骨骨不连伴缺血性坏死的效果。方法 2007年3月至2013年12月，对入院诊断为舟骨骨不连并缺血性坏死的患者例1，2间室伸肌支持带上动脉为蒂的桡骨远端背侧骨瓣，对舟骨进行切开复位内固定，并辅以外固定(2-14月)，术后随访时间平均为16.9月（2-23月）。术前、术后3月、12月及18月，通过腕关节活动度，影像学以及Mayo评分系统评估手术效果。结果 21例患者术后骨折均获愈合，平均愈合时间为13.4周(11-17周)。舟骨月骨轴线交角：术前平均为53.3°，术后3月平均为49.9°，术后12月平均为48.6°，术后18月为48.3°；Mayo功能评分：术前优良率为14.3%，术后3月为50%，术后12月为66.7%，术后18月为100%。术后腕关节各个方向活动度均较术前显著提高。结论 采用桡骨远端背侧带血管蒂骨瓣能够促进舟骨，外固定支架，使腕关节早期行功能锻炼并改善其功能。 Vascularised bone graft of 1,2 intercompartmental supraretinacular artery with external fixation in scaphoid nonuion with avascular necrosis JI Wei-ping, HAN Pei, CHAI Yi-min Department of orthopedics, No.6 Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China 【Abstract】Objectives to study the use of vascularized bone graft (VBG) in combination with an external fixation in scaphoid nonuion with avascular necrosis. Methods Between March 2007 and December 2013, we diagnosed 21 cases of scaphoid nonunion with avascular necrosis. All the patients were treated with a VBG in the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) and an external fixation. The radiological valuation included radiographies, CT and MRI. We studied the scapholunate angle and the Mayo Wrist Score. Results All cases achieved union in an average time of 13.4 weeks (11-17 weeks). X-rays and CT showed a complete osseous union in all patients. The scapholunate angle was a mean of 53.3o preoperatively, 49.9o after 3 months, 48.6 o after 12 months and 48.3癮fter 18 months postoperativelyn. Respectively, according to Mayo Wrist Score, good rate preoperative, after 3 months, 12 months and 18 months was 14.3%, 50% and 66.7% and 100%. Conclusions The technique, which uses a VBG in the vessel 1, 2 ICSRA, is successful in treating scaphoid nonunions with avascular necrosisi. We prefer to use an additional external fixation in order to restore the function of wrist rapidly. 【Key words】 Scaphoid bone; Fixation; External fixator; Microsurgery 舟骨avascula