Bürger K H, Gaggl A J, Kukutschki W, Mueller E
Unfallchirurgie, LKH Klagenfurt, Osterreich.
Handchir Mikrochir Plast Chir. 2009 Feb;41(1):44-51. doi: 10.1055/s-2008-1038765. Epub 2008 Dec 15.
Successful treatment of scaphoid non-union with avascular necrosis of the proximal poles and humpback deformity with carpal collapse is one of the main problems in reconstructive hand surgery. Vascularised bone transfer is one of the most successful techniques for treating these problems. 15 patients with avascular necrosis and non-union of the scaphoid were treated by a microvascular reanastomosed corticocancellous transplant from the distal medial femur. In all patients the success of the microvascular bone transfer was examined by MRI and conventional radiographs immediately, 6 weeks, 3, 6 and 12 months postoperatively. The transplant vitality, signs of reunion and carpal configuration were registered. Furthermore, the Mayo wrist score was employed for clinical evaluation. All transplants remained vital during the follow-up period of one year. Pseudoarthrosis was treated successfully in every case. In 14 cases there was a significant increase of the Mayo wrist score and in one case there was no difference before and after surgery. The microvascular transfer of corticocancellous femur resulted in a high rate of complete healing of scaphoid pseudoarthrosis and correction of the carpal relation.
成功治疗舟骨近端极部缺血性坏死合并驼背畸形及腕骨塌陷的舟骨不愈合是重建手部外科的主要问题之一。带血管蒂骨移植是治疗这些问题最成功的技术之一。15例舟骨缺血性坏死合并不愈合患者接受了来自股骨内侧远端的带微血管再吻合的皮质骨-松质骨移植治疗。所有患者在术后即刻、6周、3个月、6个月和12个月通过MRI和传统X线片检查微血管骨移植的成功率。记录移植骨活力、愈合迹象和腕骨形态。此外，采用Mayo腕关节评分进行临床评估。在一年的随访期内，所有移植骨均保持存活。每例假关节均成功治愈。14例患者Mayo腕关节评分显著提高，1例患者手术前后无差异。股骨皮质骨-松质骨的微血管移植导致舟骨假关节完全愈合率高，并纠正了腕骨关系。
