腕背中、远动脉弓第二交通支带蒂骨瓣治疗舟骨骨折不愈合的疗效

Effect of bone flap pedicled with the second communicating branch between dorsal wrist middle and distal arterial arch in treatment of scaphoid fracture nonunion

目的探讨采用腕背中、远动脉弓之间第二交通支为蒂的骨瓣治疗舟骨骨折不愈合的临床疗效。方法回顾性分析2015-04至2021-12河北医科大学第三医院手外科和武警河北总队医院骨科收治的32例舟状骨骨折不愈合患者的临床资料,所有患者均采用带血供的第二掌骨背侧基底骨瓣治疗,骨瓣血供基于腕背中、远动脉弓之间第二交通支。记录患者手术参数,术后腕关节活动范围采用测角仪测量,并与术前记录的测量值进行比较。使用视觉模拟量表评估手腕疼痛指数,并使用Mayo手腕评分对术后手腕功能进行评估。结果32例患者均成功完成手术,骨瓣平均尺寸为11 mm×6 mm×5 mm,平均血管蒂长16 mm。骨愈合时间8~16周,平均10周;平均随访30个月(26~37个月)。术后平均舟月角为13°(-4°~16°),明显好于术前的28°(21°~36°),差异有统计学意义(P<0.05);术后平均桡月角为10°,也明显优于术前的17°,差异有统计学意义(P<0.05)。与术前比较,术后CT冠面平均高长比、腕关节功能Mayo评分也明显优于术前。结论采用腕背中、远动脉弓之间第二交通支为蒂的第二掌骨背侧基底骨瓣治疗舟骨骨折不愈合效果显著。

Objective To investigate the clinical effect of the bone flap pedicled with the second communicating branch between dorsal wrist middle and distal arterial arch in the treatment of scaphoid fracture nonunion.Methods The clinical data of 32 patients with nonunion scaphoid bone fracture admitted to the Third Hospital of Hebei Medical University and Hebei Provincial Corps Hospital of Chinese People’s Armed Police Force from April 2015 to December 2021 were retrospectively analyzed.All patients were treated with the dorsal base bone flap of the second metacarpal bone with blood supply,which was based on the second communicating branch between the middle and distal arterial arch of the dorsal wrist.The operative parameters of the patients were recorded,and the range of motion of the wrist joint after operation was measured by the goniometer and compared with the measured values recorded before operation.The visual analogue Scale was used to assess wrist pain index and the Mayo wrist score was used to assess postoperative wrist function.Results All the 32 patients were successfully operated.The average size of bone flap was 11 mm×6 mm×5 mm and the average pedicle length was 16 mm.The bone healing time was 8-16 weeks(average 10 weeks).The average follow-up was 30 months(26-37 months).The mean navicular angle after operation was 13°(-4°-16°),which was significantly better than that before operation 28°(21°-36°),and the difference was statistically significant(P<0.05).The mean radial angle of 10°was also significantly better than that of 17°before surgery,and the difference was statistically significant(P<0.05).Compared with the preoperative results,the mean height of CT coronal surface and the Mayo score of wrist joint function were also significantly better after operation.Conclusions The use of the second metacarpal dorsal base bone flap pedicled with the second communicating branch between the dorsal middle and distal arterial arches of the wrist is effective in the treatment of scaphoid fracture nonunion.