改良第1、2间室伸肌支持带上动脉骨瓣联合Herbert钉治疗舟骨骨不连

Treatment of scaphoid nonunion with improved 1,2 intercompartmental supraretinacular artery vascularized bone flap grafting combined with Herbert screw fixation

目的探讨以改良第1，2间室伸肌支持带上动脉（the 1th，2nd intercompartmental supraretinacular artery，1，2ICSRA）为血管蒂的楔形骨瓣转移联合Herbert钉治疗舟骨骨不连的技术和疗效。方法对12例舟骨骨不连患者，设计并应用改良1，2ICSRA为血管蒂的楔形骨瓣转移联合Herbert钉进行治疗，采用腕背侧单一切口同时完成骨折内固定和骨瓣转移。结果术后随访时间为6—28个月，平均14个月。X线片显示舟骨骨折均获得骨性愈合，愈合率为100％，平均愈合时间为3．2个月。9例患者腕痛消失，活动正常，对手术效果满意，2例患者感活动时轻微疼痛，1例患者用力时有不适感。术前患手平均握力为10．3kg，术后患手平均握力是35．8kg，对侧正常手平均是37．6kg，术后握力相当于对侧93．3％，为术前的3．4倍。根据Cooney腕关节评分表，优10例，良2例，优良率100％。结论改良1，2ICSRA为血管蒂的楔形骨瓣转移联合Herbert钉能促进舟骨愈合，有利于腕部生理功能的重建，是治疗舟骨骨不连的有效方法。

Objective To explore the effect of improved 1,2 intercompartmental supraretinacular artery（ 1,2 ICSRA） vascularized grafting combined with Herbert screw fixation in the treatment of scaphoid nonunion. Methods Twelve patients＇ with scaphoid nonunion in our hospital were treated with improved 1,2 ICSRA vascularized grafting combined with Herbert screw fixation. Deformity correction and vascular- ized bone grafting were performed within a single curvilinear dorsal radial incision. Results All cases were followed up from 6 months to 28 months（ average 11.3 months）. X-Ray showed that the bone union was achieved in all the cases with a mean time of 3.2 months. Wrist pain disappeared in 9 patients, wrist activity got back to normal and the effect was satisfactory. Two patients complained about a slight pain dur- ing exercise. One patient experienced discomfort on exertion. The mean grip strength on the injuried side was 35.8 kg,which was 93.3% of the normal side（37.6 kg） and 3.4 times higher than that of the preop- erative one. According to Cooney＇s scoring system,the results were excellent in 10 and good in 2 patients, and the excellent-good rate was 100%. Conclusion Improved 1,2 ICSRA vascularized grafting combined with Herbert screw fixation can lead to good bone healing of scaphoid fracture, which is beneficial to the restoration of normal wrist mechanics and effective in the treatment of scaphoid nonunion