Herbert螺钉联合带血管蒂桡骨瓣治疗腕舟状骨骨不连

Clinical Effects of Herbert Screw Combined with Bone Flap on Scaphoid Nonunion

目的探讨Herbert螺钉联合带血管蒂桡骨骨瓣移植治疗腕舟骨骨不连的临床疗效。方法回顾性分析我科2011年3月～2016年3月行Herbert螺钉联合带血管蒂桡骨骨瓣治疗腕舟骨骨折18例，其中男14例，女4例；平均年龄30．7岁（21～54岁）；受伤至手术时间平均为14．2个月（5～25个月）；带血管蒂的桡骨背侧皮质骨瓣移植12例，带桡动脉茎突支桡骨瓣移植6例。结果所有患者随访6—24个月，骨折均愈合；Mayo腕关节功能评价：优11例，良5例，可2例。末次随访时，舟骨角、舟月角、Mayo腕关节功能评分、关节活动度、握力均较术前有显著提高。结论Herbert螺钉联合带血管蒂桡骨骨瓣治疗腕舟状骨骨不连是力学固定和生物学固定相结合的方法，临床疗效良好。

Objective To discuss clinical effects of Herbert screw combined with bone flap on scaphoid nonun- ion. Methods 18 patients with scaphoid nonunion between Mar. 2011 and Mar. 2016 were analyzed retrospectively. There were 14 males and 4 females with an average age of 30.7 years old（ range from 21 to 54 years old）. Thc average time from injury to operation was 14.2 months（ range from 5 to 25 months）. All the 18 cases were treated with Herbert screw combined with vascularized bone flap surgery,including 12 cases with radius dorsal cortex bone flap with vascu- lar pedicle and 6 cases with radial artery grafts supported radial styloid. Results All patients were followed up tbr 6 to 24 months. All fractures were healing, in which 11 cases were excellent ,5 cases were good, and 2 cases were fair according to Mayo wrist function evaluation. Navicular angle, scapholunate angle, Mayo wrist function score, range of motion, grip strength were improved significantly at the final follow - up. Conclusion Herbert screw combined with vascularized bone flap for scaphoid nonunion is a method of mechanical fixation and biological fixation with good clinical efficacy.