自体松质骨富血小板血浆植入联合带血管蒂骨膜瓣转位治疗腕舟骨骨不连伴骨坏死

Autologous cancellous bone and platelet-rich plasma implantation combined with vascularized periosteal flap transposition in the treatment of carpal scaphoid nonunion with osteonecrosis

目的探讨应用自体松质骨富血小板血浆(platelet-rich plasma,PRP)混合物病灶植入联合带血管蒂骨膜瓣转位治疗腕舟骨骨不连伴骨坏死的临床疗效。方法自2017年6月至2020年1月,我科应用自体松质骨PRP混合物病灶植入联合带血管蒂骨膜瓣转位治疗腕舟骨骨不连伴骨坏死患者16例,其中腰部骨不连7例,近极骨不连9例。记录手术时长并随访观察切口及骨折愈合情况。末次随访后比较术前术后腕关节屈伸活动度、握力、疼痛视觉模拟评分(visual analogue scale,VAS)、腕关节改良Mayo功能评分。结果术后所有患者均获得随访,时间为11~25个月,平均(13.1±2.6)个月。手术时长55~92 min,平均(66.0±9.3)min。所有骨折均骨性愈合,愈合时间为12-23周,平均(13.3±0.5)周,随访结束时无新发骨坏死病灶形成。末次随访时,患腕屈伸活动度、平均握力.VAS疼痛评分及腕关节改良Mayo评分均优于术前(P<0.01)。结论自体松质骨PRP混合物病灶植入联合带血管蒂骨膜瓣转位治疗腕舟骨骨不连伴骨坏死临床效果良好,值得进--步研究推广。

Objective To investigate the clinical efficacy of focal implantation of autologous cancellous bone and platelet-rich plasma(PRP)mixture combined with vascularized periosteal flap transposition in the treatment of carpal scaphoid nonunion with osteonecrosis.Methods From June 2017 to January 2020,16 cases of carpal scaphoid nonunion with osteonecrosis were treated with autologous cancellous bone and PRP mixture focus implantation combined with vascularized periosteal flap transposition,including 7 cases of lumbar nonunion and 9 cases of proximal polar nonunion.The operation time was recorded and the situation of incision and fracture healing was observed by follow-up.After the last follow-up,the wrist flexion and extension range of motion,grip strength,visual analogue scale(VAS)and modified Mayo function score were compared before and after operation.Results All the patients were follow-up for 11 to 25 months,with an average of(13.1±2.6)months.The operation time was 55 to 92 minutes,with an average of(66.0±9.3)minutes.All the fractures achieved bony healing.The healing time was 12 to 23 weeks,with an average of(13.3±0.5)weeks.At the end of follow-up,no new osteonecrosis lesions were formed.At the last follow-up,the wrist flexion and extension range of motion,average grip strength,VAS pain score and wrist modified Mayo score were better than those before operation(P<0.01).Conclusion The application of autologous cancellous bone and PRP mixture focus implantation combined with vascularized periosteal flap transposition has a good clinical effect in the treatment of carpal scaphoid nonunion with osteonecrosis,which is worthy of further research and promotion.