del Piñal Francisco, Klausmeyer Melissa, Moraleda Eduardo, de Piero Guillermo H, Galindo Carlos, Studer Alexis, Cerezal Luis
Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain.
J Hand Surg Am. 2013 Oct;38(10):1883-95. doi: 10.1016/j.jhsa.2013.07.013.
To present our experience of reconstructing distal radius articular defects with a vascularized osteochondral graft from the metatarsal base and to present the mid-term outcomes.
Seven patients (average age, 36 y; range, 26-55 y) who had reconstruction of major defects of the articular surface of the radius are presented. In 5, the lunate facet and sigmoid notch were reconstructed; in 1, an isolated defect on the surface of the lunate facet was reconstructed; and in 1, the scaphoid facet was reconstructed. In 6, the base of the third metatarsal was transferred, and in 1, the base of the second was transferred.
All flaps survived without complications. At the latest follow-up (range, 20 mo to 8 y), the flexion-extension arc improved an average of 50°, and the pain on a visual analog scale decreased from 8 to 1 on average. Disabilities of the Arm, Shoulder, and Hand score improved from 54 to 11 on average. One patient did not improve. No major complaints related to the donor site were mentioned (average American Orthopedic Foot and Ankle Society score of 96/100).
Our mid-term results are promising; however, the decision-making process and the operation are complex. The operation is not indicated when the carpals are devoid of cartilage or when the defect involves the whole radius surface.
介绍我们使用来自跖骨基底的带血管蒂骨软骨移植重建桡骨远端关节缺损的经验，并展示中期结果。
介绍了7例（平均年龄36岁；范围26 - 55岁）桡骨关节面重大缺损重建患者。其中5例重建月骨小面和乙状切迹；1例重建月骨小面表面孤立缺损；1例重建舟骨小面。6例转移第三跖骨基底，1例转移第二跖骨基底。
所有皮瓣均存活，无并发症。在最近一次随访时（范围20个月至8年），屈伸弧度平均改善50°，视觉模拟量表上的疼痛平均从8降至1。上肢、肩部和手部残疾评分平均从54改善至11。1例患者未改善。未提及与供区相关的主要主诉（美国矫形足踝协会平均评分为96/100）。
我们的中期结果很有前景；然而，决策过程和手术较为复杂。当腕骨无软骨或缺损累及整个桡骨表面时，不建议进行该手术。
