Lim Tae Kang, Kim Hyo Kon, Koh Kyoung Hwan, Lee Hyun Il, Woo Sung Jong, Park Min Jong
Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, Korea; Department of Orthopaedic Surgery, MS Jaegeon Hospital, Daegu, Korea; Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea; Department of Orthopaedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Korea; Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Hand Surg Am. 2013 Oct;38(10):1906-12.e1. doi: 10.1016/j.jhsa.2013.07.025.
To investigate the outcomes of vascularized distal radius pedicled bone grafting secured with K-wires for scaphoid nonunions with small avascular proximal fragments.
We included patients with scaphoid nonunions and small, avascular proximal fragments that were too small for screw fixation. The mean size of the proximal pole fragments was 21% (range, 9% to 28%) of the entire scaphoid, based on quantitative radiographic measurement. All patients had distal radius bone grafting based on the 1,2-intercompartmental supraretinacular artery pedicle and fixation with K-wires. There were 21 wrists in 18 men and 2 women with the mean age of 34 years (range, 22 to 57 y). The mean duration of postoperative follow-up was 40 months (range, 12 to 103 mo). Radiographic union and clinical outcomes, including the ranges of wrist motion, grip strength, and the modified Mayo wrist score, were evaluated.
Union was achieved in 18 of 21 wrists (86%) at a mean time of 14 weeks after surgery (range, 8 to 28 wk). Nonunions with proximal fragments less than 20% of the total scaphoid healed in 6 of 8 wrists. In a subset of these 8 wrists in which the proximal fragment was less than 15%, healing occurred in 2 of 4. The modified Mayo wrist score significantly improved from 46 to 78 points, and final wrist functions were rated as excellent in 5, good in 5, fair in 10, and poor in 1. Ranges of motion and grip strengths did not show significant changes after surgery.
Vascularized distal radius bone grafting and K-wire fixation can heal scaphoid nonunions with small avascular proximal fragments, although motion and grip strength remain unchanged. Healing may be related to the size of the proximal pole fragment.
探讨采用克氏针固定的带血管蒂桡骨远端骨移植治疗舟骨不愈合合并小的无血管近端骨折块的疗效。
纳入舟骨不愈合且近端骨折块小、无血管且无法用螺钉固定的患者。根据X线定量测量，近端极骨折块的平均大小为整个舟骨的21%（范围为9%至28%）。所有患者均采用基于1,2间室上支持带动脉蒂的桡骨远端骨移植并用克氏针固定。共21例腕关节，其中男性18例，女性2例，平均年龄34岁（范围为22至57岁）。术后平均随访时间为40个月（范围为12至103个月）。评估X线愈合情况及临床疗效，包括腕关节活动范围、握力及改良梅奥腕关节评分。
21例腕关节中有18例（86%）实现愈合，平均愈合时间为术后14周（范围为8至28周）。近端骨折块小于舟骨总体积20%的8例不愈合患者中，有6例愈合。在这8例近端骨折块小于15%的亚组患者中，4例中有2例愈合。改良梅奥腕关节评分从46分显著提高至78分，最终腕关节功能评为优5例、良5例、可10例、差1例。术后活动范围和握力无显著变化。
带血管蒂桡骨远端骨移植及克氏针固定可使合并小的无血管近端骨折块的舟骨不愈合实现愈合，尽管活动度和握力未改变。愈合可能与近端极骨折块的大小有关。
