Rochester, Minn. From the Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic.
Plast Reconstr Surg. 2010 Apr;125(4):1176-1184. doi: 10.1097/PRS.0b013e3181d1808c.
Scaphoid nonunions with associated avascular necrosis and carpal collapse have proven difficult to treat reliably. This study outlines the rationale and approach to the use of a free-vascularized medial femoral condyle bone graft and the authors' experience with it in the treatment of scaphoid nonunions.
A retrospective review was conducted to identify all patients with scaphoid nonunions with avascular necrosis and carpal collapse treated with a medial femoral condyle bone graft. Between July of 2004 and August of 2007, 12 such patients (12 men and no women), with a mean age of 25.3 years (range, 18 to 40 years), were identified. Nine of the twelve had failed prior operative treatment. Mean duration of nonunion was 20 months (range, 4 to 36 months). Carpal indices, time to union, early functional outcomes, and complications were recorded.
All 12 nonunions healed at a mean of 13 weeks (range, 6 to 26 weeks). Radiographic evaluation demonstrated significant improvement from preoperative to postoperative mean lateral intrascaphoid angle (66 and 28 degrees, respectively; p = 0.00005), scaphoid height-to-length ratio (0.78 and 0.65 respectively; p = 0.006), scapholunate angle (63 and 49 degrees, respectively; p = 0.001), and radiolunate angle (15 and 6 degrees, respectively; p = 0.0005). Five patients underwent subsequent procedures (one radial styloidectomy and four Kirschner wire removals, with one concurrent donor-site stitch abscess débridement).
Free-vascularized medial femoral condyle grafts provide both blood supply and structural support to restore scaphoid vascularity and architecture, thereby promoting union. These results suggest that this graft is a promising alternative in the treatment of scaphoid nonunions associated with avascular necrosis and carpal collapse.
伴有缺血性坏死和腕骨塌陷的舟骨骨不连很难得到可靠的治疗。本研究概述了使用游离血管化股骨内侧髁骨移植物的原理和方法，并介绍了作者在治疗舟骨骨不连中的经验。
回顾性分析 2004 年 7 月至 2007 年 8 月期间采用股骨内侧髁骨移植物治疗伴有缺血性坏死和腕骨塌陷的舟骨骨不连的 12 例患者（男性 12 例，女性 0 例；平均年龄 25.3 岁，范围为 1840 岁）。其中 9 例患者先前接受过手术治疗失败。骨不连的平均持续时间为 20 个月（范围为 436 个月）。记录腕骨指数、愈合时间、早期功能结果和并发症。
所有 12 例骨不连在平均 13 周（范围为 6~26 周）时愈合。影像学评估显示，术前与术后的侧位舟状骨内角（分别为 66°和 28°；p=0.00005）、舟骨长径比（分别为 0.78 和 0.65；p=0.006）、舟月角（分别为 63°和 49°；p=0.001）和桡月角（分别为 15°和 6°；p=0.0005）有显著改善。5 例患者随后进行了手术（1 例行桡骨茎突切除术，4 例行克氏针取出术，其中 1 例同时行供区缝线脓肿清创术）。
游离血管化股骨内侧髁骨移植物既能提供血供，又能提供结构支撑，从而恢复舟骨的血运和结构，促进愈合。这些结果表明，该移植物是治疗伴有缺血性坏死和腕骨塌陷的舟骨骨不连的一种有前途的方法。
