Kamrani Reza Shahryar, Mehrpour Saeed Reza, Sorbi Reza, Aghamirsalim Mohammadreza, Farhadi Leila
Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Kargar Shomali Street, Tehran, Iran.
J Orthop Sci. 2013 Jul;18(4):563-8. doi: 10.1007/s00776-013-0395-0. Epub 2013 Apr 19.
Reconstructions of forearm fracture nonunions are frequently complex. A few studies that help guide the treatment of forearm nonunion have been reported. We offer a novel surgical technique to treat nonunion of the forearm using a regional vascularized bone graft.
Four females and 5 males ranging from 27 to 74 years of age with 7 ulna and 2 radius nonunions were surgically treated by pedicle grafting with a posterior interosseous bone flap (PIBF) and internal fixation with a plate. There were no cases with extensive soft tissue damage or infection. Pre- and postoperatively (mean 21 months), all patients were assessed by radiographs and for function by the Disabilities of the Arm, Shoulder and Hand (DASH) score.
Function of the upper extremity was improved in all patients. DASH scores improved from 61.2 points pre-operatively to 12 points at final follow-up. All nonunions were united uneventfully.
Following debridement of the necrotic tissue, the bone defect can be filled with a vascularized graft from posterior interosseous pedicles. Pedicled PIBF is a safe and useful novel technique in cases of atrophic or hypertrophic nonunion of the middle third of the radius or proximal two-thirds of the ulna.
前臂骨折不愈合的重建手术通常较为复杂。已有一些有助于指导前臂不愈合治疗的研究报道。我们提供一种使用带血管蒂骨瓣治疗前臂不愈合的新型手术技术。
对4名女性和5名男性患者（年龄27至74岁）的7例尺骨和2例桡骨不愈合进行手术治疗，采用带蒂骨瓣移植，即后骨间骨瓣（PIBF），并用钢板进行内固定。无广泛软组织损伤或感染病例。术前及术后（平均21个月），所有患者均行X线片检查，并采用上肢、肩部和手部功能障碍（DASH）评分评估功能。
所有患者上肢功能均有改善。DASH评分从术前的61.2分提高到最终随访时的12分。所有不愈合均顺利愈合。
清除坏死组织后，骨缺损可用后骨间血管蒂骨瓣填充。带蒂PIBF对于桡骨中1/3或尺骨近端2/3萎缩性或肥大性不愈合是一种安全有效的新技术。
