腕舟骨骨不连手术治疗16例临床分析.docVIP

精品论文 参考文献 腕舟骨骨不连手术治疗16例临床分析 1.胶州市人民医院 手外科 山东胶州 266300；2.黄岛区人民医院 骨科 青岛黄岛 266400 摘要：目的 探讨腕舟骨骨不连的手术治疗方法和临床效果。方法 2007年1月至2014年9月，我院收治16例腕舟骨骨不连患者，采用桡背侧入路带桡骨茎突返支血管蒂桡骨瓣转移治疗腕舟骨骨不连8例，其中合并桡骨茎突切除手术4例；采用桡掌侧入路旋前方肌桡骨瓣转移4例，采用桡掌侧入路吻合血管游离髂骨瓣移植手术4例。结果 本组16例均获得随访，随访时间随访6～40个月，愈合时间3～8个月，骨性愈合率87.5%，腕关节功能恢复，无腕关节不稳发生，其中2例手握力差，腕关节疼痛，疗效较差，优良率87.5%。结论 根据每个患者舟骨骨不连的具体特点，骨坏死的部位、程度、骨折的稳定性以及有无驼背畸形、腕骨塌陷、有无创伤性关节炎、局部软组织创伤程度等，制定个性化手术治疗方案，各手术方法疗效可靠，临床效果较好。 关键词：腕舟骨骨不连；骨瓣；转移；移植；手术 [Abstract]Objective To investigate the clinical effect and operation method of treatment of carpal scaphoid bone nonunion.Methods from 2007 January to 2014 September in our hospital，16 cases of scaphoid nonunion patients，the radial dorsal approach with radial styloid recurrent branch of radial vascular pedicle flap transfer for treatment of scaphoid nonunion in 8 cases，of which 4 cases complicated with excision of the radial styloid operation；radial volar pronator radial bone flap metastasis in 4 cases，radial volar vascularized free iliac bone flap transplantation operation in 4 cases.Results of the 16 cases were followed up for 6～40 months follow-up，follow-up time，healing time was 3～8 months，bone healing rate was 87.5%，the recovery of wrist joint function，without carpal instability occurred，of which 2 cases of hand grip strength is poor，poor efficacy of pain，wrist joint，the excellent and good rate was 87.5%.Conclusion according to the specific characteristics of each patient with nonunion of scaphoid bone，bone necrosis of the location，degree，fracture stability and no kyphosis，carpal collapse，there is no traumatic arthritis，local soft tissue trauma degree，develop personalized operation treatment scheme，the efficacy of the operation method is reliable，better clinical effect. [key words]carpal scaphoid bone nonunion；Bone flap；Transfer；Transplantation；surgery 舟骨骨折是腕部常见的骨折之一，腕舟骨解剖位置特殊，腕舟骨骨折发生后，由于骨折近端缺血、漏诊误诊或初期处理不当导致骨折端剪力增加，常常导致舟骨不愈合、骨不连。对于舟骨近端大块骨坏死、驼背畸形、腕骨塌陷患者，目前缺乏可靠的治疗方法【1】，即使带血管的骨瓣转移也不可靠。2007年1月至2014年9月，我院收