Hirche Christoph, Heffinger Christian, Xiong Lingyun, Lehnhardt Marcus, Kneser Ulrich, Bickert Berthold, Gazyakan Emre
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, University of Heidelberg, BG Trauma Center Ludwigshafen, Germany.
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, University of Heidelberg, BG Trauma Center Ludwigshafen, Germany.
J Hand Surg Am. 2014 Mar;39(3):423-9. doi: 10.1016/j.jhsa.2013.10.028. Epub 2014 Jan 18.
To evaluate the clinical outcome of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone graft for scaphoid nonunion (SN).
A retrospective study was performed to evaluate patients with SN and treated with 1,2-intercompartmental supraretinacular artery pedicled vascularized bone graft between 1997 and 2010. Functional measures, quality of life by Short Form SF-36 questionnaire, and analysis of risk factors were included.
Out of 39 patients who were eligible for the study, 11 were lost to follow-up. Out of the remaining 28 patients, union was achieved in 21 (75%). The mean length of follow-up was 63 ± 45 months. In hands with scaphoid union, the grip strength and the radioulnar active range of motion were less than the contralateral side but greater compared with patients with nonunion. Active extension-flexion was less compared with the noninjured hand but similar to patients with nonunion. Disabilities of the Arm, Shoulder and Hand (DASH) score decreased from 58 to 23 in dominant hands and from 46 to 13 in nondominant hands. Smoking was found to be a risk factor for nonunion. Patients with scaphoid union tended to higher scores in 8 domains of SF-36-Item Health Survey quality of life without significant difference.
Surgical treatment of SN with 1,2-intercompartmental supraretinacular artery pedicled vascularized bone graft provided a union rate comparable with other vascularized bone graft techniques. Previous scaphoid reconstruction with standard iliac crest bone graft was not associated with higher risk for secondary nonunion. There was an upward tendency seen in DASH score and quality of life after scaphoid union.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
评估1,2间室视网膜上动脉带蒂血管化骨移植治疗舟骨不连（SN）的临床疗效。
进行一项回顾性研究，以评估1997年至2010年间接受1,2间室视网膜上动脉带蒂血管化骨移植治疗的SN患者。纳入功能测量、采用简短健康调查问卷（SF-36）评估生活质量以及危险因素分析。
在39例符合研究条件的患者中，11例失访。其余28例患者中，21例（75%）实现骨愈合。平均随访时间为63±45个月。在舟骨愈合的手部，握力和桡尺关节主动活动范围小于对侧，但与未愈合患者相比更大。主动屈伸活动度小于未受伤手，但与未愈合患者相似。优势手的上肢、肩部和手部功能障碍（DASH）评分从58降至23，非优势手从46降至13。发现吸烟是骨不连的一个危险因素。舟骨愈合的患者在SF-36项健康调查生活质量的8个领域得分往往较高，但无显著差异。
采用1,2间室视网膜上动脉带蒂血管化骨移植手术治疗SN，其骨愈合率与其他血管化骨移植技术相当。既往采用标准髂嵴骨移植进行舟骨重建与二次骨不连的较高风险无关。舟骨愈合后，DASH评分和生活质量有上升趋势。
研究类型/证据水平：治疗性IV级。
