Larson A Noelle, Bishop Allen T, Shin Alexander Y
Mayo Clinic, Department of Orthopedic Surgery, Division of Hand Surgery, Rochester, MN, USA.
Tech Hand Up Extrem Surg. 2006 Dec;10(4):212-23. doi: 10.1097/01.bth.0000231579.32406.17.
Fractures of the scaphoid, particularly its proximal pole, are at risk of progressing to nonunion because of the tenuous, retrograde blood supply. The overall incidence of scaphoid fractures developing nonunion ranges from 10% to 15%, whereas proximal pole fractures of the scaphoid can have up to a 30% incidence of nonunion. Avascular necrosis of these proximal pole fractures can occur in 14% to 39% of cases. Dorsal distal radius vascularized pedicled bone grafting is an alternative to conventional measures for the treatment of displaced proximal pole fractures, established nonunions, and avascular necrosis of the proximal fragment. This graft is based on the 1,2-intercompartmental supraretinacular artery, which has reliable anatomy and predictable course between the first and second extensor compartments. The graft can be harvested and inset into the prepared fracture site using a single-incision approach. The indications, contraindications, technique, and results of treatment are reviewed and detailed.
舟骨骨折，尤其是其近端骨折，由于血供脆弱且呈逆行性，有发展为骨不连的风险。舟骨骨折发生骨不连的总体发生率为10%至15%，而舟骨近端骨折的骨不连发生率可达30%。这些近端骨折的缺血性坏死在14%至39%的病例中会发生。桡骨远端背侧带血管蒂骨移植是治疗移位的近端骨折、已形成的骨不连以及近端骨折块缺血性坏死的传统措施的替代方法。该移植骨基于1,2-骨间上支持带动脉，其解剖结构可靠，在第一和第二伸肌间室之间走行可预测。该移植骨可通过单切口入路获取并植入准备好的骨折部位。本文对治疗的适应证、禁忌证、技术及结果进行了回顾并详细阐述。
