带第一、二伸肌室间支持带上动脉的桡骨茎突骨瓣植骨结合Herbert钉固定治疗腕舟骨骨折不愈合

Scaphoid nonunion treated with a pedicled vascularized bone graft with 1, 2-intercompartmental supraretinacular artery and herbert screw fixation

目的观察采用带第一、二伸肌室间支持带上动脉(the 1st,2nd intercompartmental supra-retinacular artery,1,2-ICSRA)的桡骨茎突骨瓣植骨结合Herbert钉固定治疗腕舟骨骨折不愈合的临床疗效。方法回顾性分析2014年11月至2016年4月于湖北医药学院附属人民医院骨关节外科采用带1,2-ICSRA血管蒂的桡骨茎突骨瓣植骨结合Herbert钉固定治疗腕舟骨骨折不愈合的17例病人的临床资料,对比其手术前后的改良Mayo腕关节评分和疼痛视觉模拟量表(visual analogue scale,VAS)评分。结果17例病人的平均随访时间为6.3个月(3.5~12.0个月)。无周围血管、神经、肌腱损伤或一过性感觉神经失用等并发症发生,带1,2-ICSRA的桡骨茎突骨瓣无松动及脱落;术后6个月骨折均愈合。术前及末次随访时的Mayo腕关节评分分别为(63.13±5.38)分、(86.38±3.25)分,VAS评分分别为(3.04±1.04)分、(1.04±0.69)分,差异均有统计学意义(t=-18.125,P=0.000;t=7.841,P=0.000);按Mayo腕关节评分:优10例,良6例,可1例,差0例,优良率为94.12%。结论采用带1,2-ICSRA的桡骨茎突骨瓣植骨结合Herbert钉固定治疗腕舟骨骨折不愈合可取得良好的临床效果。

Objective To observe the clinical effect of scaphoid nonunion treated with a pedicled vascularized bone graft with1,2-intercompartmental supraretinacular artery(1,2-ICSRA)and herbert screw fixation.Methods We retrospectively reviewed17cases suffered from scaphoid nonunion from November2014to April2016.All patients were treated with a pedicled vascularized bone graft with1,2-ICSRA and herbert screw fixation.The clinical outcomes were assessed by the modified Mayo wrist score system and Visual Analogue Scale(VAS).Results Seventeen cases were followed up for6.3months on average(from3.5months to12.0months)after operation.There were no complications such as peripheral vascular,nerve or tendon injury or transient sensory nerve loss.The pedicled vascularized bone graft with1,2?ICSRA was not loosened and dropped.The fracture healed at6th month after operation.The Mayo wrist scores before operation and at last follow-up were63.13±5.38and86.38±3.25respectively,while the VAS scores were3.04±1.04and1.04±0.69respectively,with the differences being statistically significant(t=-18.125,P=0.000;t=7.841,P=0.000).According to the Mayo wrist score,10cases obtained excellent effect,6cases good,1case bad,and0cases poor.The overall excellent and good rate was94.12%.Conclusion The clinical effect of scaphoid nonunion treated with a pedicled vascularized bone graft with1,2-ICSRA and herbert screw fixation is satisfactory,and it has a great value in clinical application.