Saffar P
Institut français de chirurgie de la main, 5 rue du Dôme, Paris, France.
Chir Main. 2010 Dec;29 Suppl 1:S112-8. doi: 10.1016/j.main.2010.09.005. Epub 2010 Nov 13.
There is a specific vascularization of the pisiform bone depending on the cubito-dorsal artery, branch of the ulnar artery. The vascularized pisiform bone may be transferred in place of the excised lunatum. The aims are to decrease pain when keeping the mobility, to replace a dead bone, to maintain the distance between scaphoid and triquetrum and radius and capitatum, by preventing the carpal collapse. X-rays and a MRI are performed. The vascularized transfer is indicated at stage III of the usual classifications. The technique is described, insisting on the transferred bone stabilization using ligament reconstructions. Radial shortening or scapho-capitate limited arthrodesis may be combined to reduce the stress on the transferred bone. Fifty-one cases have been performed at stage IIIa or IIIb and sometimes IV of the disease. The maximum follow-up is 15 years. The pain has decreased constantly. Motion in flexion-extension has an increase of more than 35°, radial and ulnar deviation of more than 14°. Strength has been slightly modified to more than 10%. The complications are: one case of "complex regional pain syndrome", one infection reoperated and one infection cured by antibiotics; one reoperation for a proximal row carpectomy. Results of this technique have been published in the literature. This technique provides regularly good results with a long follow-up. A precise technique is mandatory.
豌豆骨有特定的血管供应，依赖于尺动脉的分支肘背动脉。带血管蒂的豌豆骨可被转移以替代切除的月骨。目的是在保持活动度的同时减轻疼痛，替代坏死骨，通过防止腕骨塌陷来维持舟骨与三角骨以及桡骨与头状骨之间的距离。进行X线和磁共振成像检查。带血管蒂转移适用于常见分类中的Ⅲ期。描述了该技术，强调使用韧带重建来稳定转移的骨。可联合桡骨缩短或舟头状骨有限关节固定术以减轻转移骨上的应力。已对51例处于疾病Ⅲa期或Ⅲb期、有时为Ⅳ期的患者实施了该手术。最长随访时间为15年。疼痛持续减轻。屈伸活动度增加超过35°，桡偏和尺偏增加超过14°。力量略有改变，超过10%。并发症包括：1例“复杂性区域疼痛综合征”，1例感染经再次手术治疗，1例感染用抗生素治愈；1例因近端腕骨切除术再次手术。该技术的结果已在文献中发表。长期随访显示该技术通常能取得良好效果。必须采用精确的技术。
