Noaman Hassan Hamdy, Shiha Anis Elsayed, Ibrahim Abdel Khalek Hafez
Department of Orthopaedics, Hand and Reconstructive Microsurgical Unit, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
Ann Plast Surg. 2011 Jan;66(1):47-52. doi: 10.1097/SAP.0b013e3181d375f9.
Between 1998 and 2007, a pronator quadratus pedicled bone graft was performed for 45 patients of ununited scaphoid fracture. One of them had bilateral ununited scaphoid fracture. There were 29 men and 16 women with a median age at operation of 24 (16-32) years. The affected side was the right side (dominant hand) in 32 patients whereas 13 patients had fracture of the nondominant left side. There had been 32 proximal pseudoarthrosis (through or proximal to the junction of the proximal and middle thirds of the bone) and 14 of the middle third of the scaphoid. The original fractures were caused by motor cycle accidents in 23 patients, falling on outstretched hand in 15 patients, and sport injuries in the remaining 7 patients. Surgery was indicated from 5 months to 6 years after injury (average 43 months) because of complaints of pain on heavy work. The fracture has been missed at the initial examination in 23 patients whereas cast immobilization was done for 6 weeks and 3 months in 15 and 7 cases, respectively, that had failed to result in union. There were no preoperative osteoarthritic changes, but in 25 cases, there were avascular necrosis of the proximal fragment of the scaphoid. Forty-three patients showed radiographic union after an average of 14 weeks (12-16 weeks). One patient had dislodgement of the graft and refused to do it again. The average range of movement of wrist improved after operation. Taken as a percentage of the normal range, dorsiflexion increased from 69% to 80%, palmar flexion from 66% to 76%, radial deviation from 45% to 70%, and ulnar deviation from 67% to 84%. Grip strength improved from 82% to 92% of normal. All the patients have been able to return to their former activities with no pain.
1998年至2007年间，对45例舟骨骨折不愈合患者施行旋前方肌蒂骨移植术。其中1例为双侧舟骨骨折不愈合。患者中男性29例，女性16例，手术时的中位年龄为24岁（16 - 32岁）。32例患者骨折位于右侧（优势手），13例患者骨折位于非优势手左侧。舟骨近端假关节形成32例（骨折线通过或位于舟骨近、中1/3交界处近端），舟骨中1/3骨折14例。23例患者原骨折由摩托车事故所致，15例患者因伸手时摔倒受伤，其余7例患者因运动损伤。因从事重体力劳动时疼痛而手术，受伤后5个月至6年（平均43个月）进行手术。23例患者在初次检查时漏诊骨折，15例和7例患者分别进行了6周和3个月的石膏固定，但均未愈合。术前均无骨关节炎改变，但25例患者存在舟骨近端骨折块缺血性坏死。43例患者平均14周（12 - 16周）后影像学显示骨折愈合。1例患者移植骨移位，拒绝再次手术。术后腕关节平均活动范围改善。以正常范围的百分比计算，背伸从69%增加到80%，掌屈从66%增加到76%，桡偏从45%增加到70%，尺偏从67%增加到84%。握力从正常的82%提高到92%。所有患者均能恢复至术前活动水平，且无疼痛。
