桡动脉旋前方肌支血管蒂桡骨瓣治疗舟骨骨不连

Application of radius flap pedicled by pronator quadratus muscle branch of radial artery in the treatment of scaphoid nonunion

目的探讨应用桡动脉单一旋前方肌支血管蒂桡骨瓣治疗舟骨骨不连的效果。方法自2017年2月至2021年5月,我科应用桡动脉单一旋前方肌支血管蒂桡骨瓣转移治疗8例舟骨骨不连患者。术前X线片显示手舟骨骨折处均有超过2 mm的间隙,骨折端周围骨质硬化或吸收,其中1例骨折远、近端均广泛囊性变。手术于腕掌侧作两个不连续切口,游离桡动脉血管束,使骨瓣血管蒂远移,完成骨折内固定和骨瓣转移。术后随访骨折愈合时间、腕痛、腕关节活动度及握力等情况。结果术后随访9~22个月,平均15个月。所有病例X线片显示舟骨均获得骨性愈合,平均13.6周。7例术后疼痛均消失,腕关节活动好,局部无压痛。1例腕部重体力活动后出现中度疼痛。腕关节屈曲(50.5±3.7)°,背伸(47.1±5.7)°,握力(26.2±3.7)kg。根据改良的Mayo腕关节功能评分标准评定:优6例,良1例,可1例。结论桡动脉单一旋前方肌支血管蒂桡骨骨瓣,具有血管解剖恒定、血运丰富等优点,是治疗舟骨骨不连的理想方法。

Objective To explore the clinical efficacy of radius flap pedicled by pronator quadratus muscle branch of radial artery in the treatment of scaphoid nonunion.Methods From February 2017 to May 2021,8 patients with scaphoid nonunion were treated with the transfer of the radius flap pedicled by pronator quadratus muscle branch of radial artery.The preoperative X-ray film showed that there was a gap of more than 2 mm at the fracture of scaphoid bone,and the bone around the fracture end was sclerotic or absorbed.One case had extensive cystic changes at the distal and proximal ends of the fracture.Two discontinuous incisions were made at the palmar side of the wrist to free the vascular bundle of the radial artery,so as to move the vascular pedicle of the bone flap far away and complete the internal fixation of the fracture and the transfer of the bone flap.The postoperative fracture healing time,wrist pain,wrist joint range of motion,and grip strength were followed up.Results The postoperative follow-up period ranged from 9 to 22 months,with an average of 15 months.All X-ray films of the cases showed bony healing of the scaphoid bone,with the fracture healing time being an average of 13.6 weeks.The postoperative pain disappeared in all the 7 cases,with good wrist joint activity and no local tenderness.One case experienced moderate pain in the wrist after heavy physical activity.The range of motion of wrist was(50.5±3.7)°in flexion,(47.1±5.7)°in extension,and the grip strength was(26.2±3.7)kg.According to the modified Mayo wrist joint function scoring standard,6 cases were evaluated as excellent,1 case as good,and 1 case as fair.Conclusion The radius flap pedicled by pronator quadratus muscle branch of radial artery has the advantages of constant vascular anatomy and abundant blood supply.It is an ideal method for the treatment of scaphoid nonunion.