Rozen Warren M, Niumsawatt Vachara, Ross Richard, Leong James C, Ek Edmund W
Department of Plastic and Reconstructive Surgery, The Northern Hospital, 185 Cooper St, Epping, VIC, 3076, Australia.
Surg Radiol Anat. 2013 Sep;35(7):585-94. doi: 10.1007/s00276-013-1098-0. Epub 2013 Mar 19.
The treatment of comminuted fractures of the proximal interphalangeal joint is highly challenging due to the complexities of joint bio-mechanics and stability. The hemi-hamate osteochondral auto-graft has been popularised in this role, able to replace articular loss and restore joint stability. Recent evaluation of their long-term follow-up however has shown the early development of osteoarthritis and potential early cartilage loss, which may be due to the non-vascularised nature of the graft. We offer a new technique that maintains vascularisation of the transferred hamate fragment, and investigate the anatomical vascular basis for the technique.
Dissection and angiographic studies of ten cadaveric specimens were undertaken, exploring the vascular anatomy of the dorsal hamate. A clinical case of hemi-hamate osteochondral free flap is presented, including preoperative, intraoperative and postoperative investigation of the relevant vasculature.
Cadaveric studies demonstrated dorsal vascular supply to the hamate from the central of three dorsal carpal arches. The arch was supplied by the dorsal branch of the ulnar artery. Multiple supracapsular veins are present for use in flap venous drainage. This vascular pattern was found to be constant. A clinical case of hemi-hamate osteochondral free flap harvest demonstrated the same vascular anatomy intraoperatively. The digital artery was used as a recipient for microvascular anastomosis. Postoperative computed tomographic angiography and nuclear bone scan confirmed flap perfusion.
The hemi-hamate osteochondral flap has a reliable anatomical vascular basis, and is clinically feasible as a technique for early vascularisation of the osteochondral fragment to sustain the transferred articular cartilage.
由于指间关节生物力学和稳定性的复杂性，近端指间关节粉碎性骨折的治疗极具挑战性。半钩骨骨软骨自体移植在这方面已得到广泛应用，能够替代关节面缺损并恢复关节稳定性。然而，近期对其长期随访评估显示骨关节炎早期发展以及可能的早期软骨丢失，这可能归因于移植骨的无血管化特性。我们提供一种能维持移植钩骨碎片血管化的新技术，并研究该技术的解剖学血管基础。
对10具尸体标本进行解剖和血管造影研究，探索钩骨背侧的血管解剖结构。呈现一例半钩骨骨软骨游离皮瓣的临床病例，包括对相关脉管系统的术前、术中和术后研究。
尸体研究表明，钩骨背侧血供来自三个腕背弓中间的那个。该弓由尺动脉的背侧分支供血。存在多条关节囊上静脉用于皮瓣静脉引流。发现这种血管模式是恒定的。一例半钩骨骨软骨游离皮瓣切取的临床病例在术中显示了相同的血管解剖结构。指动脉用作微血管吻合的受区血管。术后计算机断层血管造影和核素骨扫描证实了皮瓣灌注。
半钩骨骨软骨瓣具有可靠的解剖学血管基础，作为一种使骨软骨碎片早期血管化以维持移植关节软骨的技术在临床上是可行的。
