带血管桡骨瓣转移填塞治疗月骨缺血坏死效果及安全性分析

Clinical effect and safety analysis of vascular radial valve transfer packing in treatment of ischemic necrosis of the lunate

目的探讨带血管桡骨瓣转移填塞治疗月骨缺血坏死的临床效果及安全性。方法收集2015年8月至2016年6月行带血管桡骨瓣转移填塞治疗的32例月骨缺血坏死患者的临床资料进行回顾性分析。采用X线片检测健侧、患侧腕关节高度及桡舟角,用量角器测量腕关节活动度,用Jamar测力计测量握力,用疼痛视觉模拟评分(VAS)评估腕关节疼痛,用Evans评分系统评估腕关节功能。结果术后随访8~22个月,平均10.3个月。32例患者术后均获得切口Ⅰ期愈合,均无严重并发症发生。末次随访时与术前比较,患侧腕高度指数、桡舟角均明显改善(t=-4.05,P=0.01;t=5.17,P=0.00);掌屈、背伸均明显改善(t=7.25,P=0.00;t=8.13,P=0.00);握力明显提高(t=10.47,P=0.00);腕关节VAS明显降低(t=5.70,P=0.00);腕关节功能Evans评分优良率为87.5%;无腕骨塌陷和骨性关节炎病例。结论带血管桡骨瓣转移填塞治疗月骨缺血坏死,可明显改善患侧腕关节疼痛与握力,减小腕关节功能受限程度,近期疗效与安全性较高。

Objective To investigate the clinical effect and safety of vascular radial valve transfer packing in the treatment of ischemic necrosis of the lunate.Methods The clinical data of 32 patients with ischemic necrosis of the lunate from August 2015 to June 2016 were analyzed retrospectively.The height of contralateral,ipsilateral wrist height and radial boat angle were measured by X-ray,grip strength was measured by the Jamar dynamometer,wrist pain was assessed using the pain visual analogue scale（VAS）,and wrist function was assessed using the Evans scoring system.Results The patients were followed up for 8-22 months,with an average of 10.3months.All the 32 cases received Ⅰincisions healing and no serious complications occurred.At the last follow-up visit,the wrist height index and radial boat angle were significantly improved（t=-4.05,P=0.01;t=5.17,P=0.00）;palmar flexion and dorsiflexion were significantly improved（t=7.25,P=0.00;t=8.13,P=0.00）;grip strength was significantly improved（t=10.47,P=0.00）;wrist pain and VAS scores were significantly decreased（t=5.70,P=0.00）.The excellent rate of wrist function Evans score was 87.5%;there were no cases of carpal collapse and osteoarthritis.Conclusion The treatment of vascular radial valve transfer packing on ischemic necrosis of the lunate can significantly improve theipsilateral wrist pain and grip strength,reduce the wrist joint functional limitation,and improve short-term efficacy and safety.