Bürger Heinz K, Windhofer Christian, Gaggl Alexander J, Higgins James P
Privat Hospital Maria Hilf, Klagenfurt, Austria.
J Hand Surg Am. 2013 Apr;38(4):690-700. doi: 10.1016/j.jhsa.2013.01.036. Epub 2013 Mar 6.
The descending geniculate artery's branching pattern includes periosteal vessels supplying the cartilage-bearing trochlea of the medial patellofemoral joint. Previous cadaveric studies described anatomic similarities between the greater curvature of the proximal scaphoid and the convex surface of the medial femoral trochlea (MFT). We describe the technique and report our first 16 consecutive cases of vascularized osteocartilaginous arthroplasty for chronic scaphoid proximal pole nonunions using the MFT, with a minimum of 6 months of follow-up.
Chart reviews of 16 consecutive cases of osteocartilaginous MFT flap transfers for scaphoid reconstruction were performed at 2 institutions. Follow-up data were recorded at a minimum of 6 months, with an average of 14 months (range, 6-72 mo). Patient age and sex, duration of nonunion, number of previous surgical procedures, surgical technique, achievement of osseous union, preoperative and postoperative scapholunate angles, preoperative and postoperative range of motion, and pain relief were recorded.
Computed tomography imaging confirmed healing in 15 of 16 reconstructed scaphoids. Mean patient age was 30 years (range, 18-47 y). The average number of previous surgical procedures was 1 (range, 0-3). All patients experienced some wrist pain improvement (12/16 complete relief, 4/16 incomplete relief). Wrist range of motion at follow-up averaged 46° extension (range, 28° to 80°) and 44° flexion (range, 10° to 80°), which was similar to preoperative measurements (average 46° extension and 43° flexion). Scapholunate relationship remained unchanged with average scapholunate angles of 52° before surgery and 49° after surgery.
Osteochondral vascularized MFT flaps provide a reliable means of achieving resolution of difficult proximal pole scaphoid nonunions. These flaps allow resection of the proximal portion of the unhealed scaphoid and reconstruction with an anatomically analogous convex segment of cartilage-bearing bone. This technique provides the advantages of vascularized bone and ease of fixation. Early follow-up demonstrates a high rate of union with acceptable motion and pain relief.
Early follow-up suggests that the vascularized MFT osteocartilaginous flap is a valuable tool for treating challenging proximal pole scaphoid nonunions.
膝降动脉的分支模式包括供应内侧髌股关节含软骨滑车的骨膜血管。以往的尸体研究描述了舟骨近端大弯与股骨内侧滑车（MFT）凸面之间的解剖学相似性。我们描述了该技术，并报告了我们连续16例使用MFT治疗慢性舟骨近端极不愈合的带血管蒂骨软骨关节成形术的病例，随访时间至少6个月。
在2家机构对连续16例采用MFT带蒂骨软骨瓣转移进行舟骨重建的病例进行病历回顾。随访数据记录时间至少为6个月，平均为14个月（范围6 - 72个月）。记录患者的年龄和性别、不愈合持续时间、既往手术次数、手术技术、骨愈合情况、术前和术后舟月角、术前和术后活动范围以及疼痛缓解情况。
计算机断层扫描成像证实16例重建舟骨中有15例愈合。患者平均年龄为30岁（范围18 - 47岁）。既往手术平均次数为1次（范围0 - 3次）。所有患者的腕部疼痛均有改善（12/16完全缓解，4/16部分缓解）。随访时腕部活动范围平均伸展46°（范围28°至80°），屈曲44°（范围10°至80°），与术前测量值相似（平均伸展46°，屈曲43°）。舟月关系保持不变，术前舟月角平均为52°，术后为49°。
带血管蒂的MFT骨软骨瓣为解决困难的舟骨近端极不愈合提供了一种可靠的方法。这些瓣允许切除未愈合舟骨的近端部分，并用解剖学上类似的含软骨骨凸段进行重建。该技术具有带血管蒂骨的优点且固定简便。早期随访显示愈合率高，活动度和疼痛缓解情况可接受。
早期随访表明，带血管蒂的MFT骨软骨瓣是治疗具有挑战性的舟骨近端极不愈合的一种有价值的工具。
