带血管蒂桡骨瓣移位术治疗月骨缺血性坏死

Vascular pedicled iliac radial graft for the treatment of ischemic necrosis of lunate bone

目的 探讨应用第4、5伸肌室间支持带上动脉为蒂桡骨瓣移植治疗腕月骨骨坏死的手术方法.方法 根据桡骨背侧远端血液供应的解剖学基础,设计带第4、5伸肌室间支持带上动脉为蒂桡骨瓣,移植治疗腕月骨坏死6例,Litchtman分期Ⅲa期4例,Ⅲb期2例.术后随访患者症状、腕关节活动度和腕关节影像学的改变进行功能评定.结果 术后随访10～27个月,4例腕静息痛消失；2例腕静息痛好转,腕关节用力活动后,出现酸痛不适;1例腕关节疼痛好转7个月后复发.腕关节功能较术前有明显改善.术后X线片显示月骨高密度坏死骨质部分吸收,并有新骨形成.腕高比值和桡舟角轻度改变.结论 第4、5伸肌室间支持带上动脉为蒂桡骨瓣移植治疗腕月骨骨坏死,初步疗效良好.

Objective To study the vascular pedicled iliac radial graft from the fourth and fifth extensor retinaculum for the treatment of ischemic necrosis of lunate bone of wrist.Methods The vascular pedicled iliac radial graft from the fourth and fifth extensor retinaculum was designed according to the anatomical basis of blood supply in the dorsal side of distal radius,and made for the treatment of six patients,four patients were in the stage of IlIa and two patients were in the stage of ]lib by Litchtman standard,with ischemic necrosis of lunate bone of wrist.The changes of the symptoms, the motion of wrist joint,the imaging of wrist joint were followed up and evaluated after the surgery.Results The time of following up were from 10 months to 27 months.Rest pain in the wrist of four patients disappeared,the rest pain in the wrist of two patients was improved and there was no aching pain in wrist after hard activities.The pain in wrist was re- lapsed after seven months of improving.The function of wrist was significantly improved after surgery.Examination of X-ray showed that partial absorption of high density necrotic lunate bone and new bone was developmented.The carpal height ratio and radioscaphoid angle were little changed after surgery.Conclusion The vascular pedicled iliac radial graft from the fourth and fifth extensor retinaculum for the treatment of ischemic necrosis of lunate bone of wrist has good effect.