陈旧性腕舟骨骨折的治疗分析

Analysis of the treatment to old fracture of scaphoid bone

目的 通过对腕舟骨骨不连三种治疗方法的临床观察与分析,探讨治疗腕舟骨骨不连接的有效手术方法。方法 从1988年～2001年,采用桡骨茎突切除加植骨术治疗腕舟骨骨折骨不连11例,桡骨茎突切除植骨加游离骨膜移植术5例,带血管筋膜蒂的第二掌骨骨瓣移位术6例。结果术后 22例获得随访,随访时间4个月～12年,骨性愈合率 100％,愈合时间为 3～4个月,腕关节功能完全恢复,无腕关节不稳、创伤性关节炎等并发症发生。结论 三种手术方法有各自的适应证:桡骨茎突切除加植骨适用于无坏死的陈旧舟骨骨折;桡骨茎突切除植骨加游离骨膜移植适用于舟骨断端植骨后有间隙,软骨缺损的舟骨骨折;带血管筋膜蒂的第二掌骨骨瓣适用于舟骨近端无菌坏死的舟骨骨折。

Objective To search an effect method to treat Carpal Scaphoid Bone Nonunion (CSBN) ,according to clinical observation and analysis of three treating methods to CSBN . Methods 11 cases of CSBN were cured with Radius Processus Styloideus Resect Plus Bone Grafting (RPSRBG) , 5 cases were cured with Radius Processus Styloideus Resect plus Bone Grafting plus Free Periost Grafting (RPSRGFPG ) , 6 cases were cured with transposition of the second Metacarpal bone Flap with Vasculofacial Pedicle ( TSMFVP) .Results 22 cases were followed-up, bone healing rate is 100%. Carpal joint function recovered completely ,no carpal joint unsteadiness was found. Conclusion Three operative methods have their own indication. RPSR?BG is fit for old scaphoid bone fracture of sterile necrosis . RPSRBGFGP is fit for the scaphoid bone fracture that there is spatium and cartilage defection after fracture bone grafting . TSMFVP is fit for the scaphoid bone with sterile necrosis in proximal end .