Kalb K
, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Deutschland.
Orthopade. 2016 Nov;45(11):966-973. doi: 10.1007/s00132-016-3334-x.
Avascularity of fragments is a common problem in treatment of scaphoid nonunion. Therefore, vascularised bone grafts have gained increasing importance. Especially the free vascularised femoral trochlea flap has become the subject of special interest because of its particular characteristics in the last few years.
Indications for and the technique of free vascularised corticocancellous as well as osteocartilagineous femoral trochlea flap are reported according to the author's practice combined with an evaluation of these methods considering current literature.
Indications for the free vasscularised corticocancellous femoral trochlea flap include scaphoid nonunion with avascular proximal fragment combined with humpback deformity, previous operations, extensive bone defect, and long standing nonunion. The free vascularised osteocartilagineous medial trochlea flap may replace a destroyed proximal scaphoid pole. The literature reports only a few patients with healing rates between 80 and 100 %.
Both corticocancellous and osteocartilagineous free vascularised medial trochlea flap improve therapeutic options in treatment of difficult scaphoid nonunion. Until now only the results of a few patients have been published. Therefore, a final evaluation will be possible when long-term results in a reasonable number of patients are available.
骨折块缺血是舟骨不愈合治疗中的常见问题。因此，带血管蒂骨移植的重要性日益增加。特别是游离带血管蒂股骨滑车瓣因其近年来的特殊特性而成为特别关注的对象。
根据作者的实践，结合当前文献对这些方法的评估，报告游离带血管蒂皮质松质骨以及骨软骨股骨滑车瓣的适应证和技术。
游离带血管蒂皮质松质骨股骨滑车瓣的适应证包括舟骨不愈合合并近端骨折块缺血、驼背畸形、既往手术史、广泛骨缺损和长期不愈合。游离带血管蒂骨软骨内侧滑车瓣可替代已破坏的舟骨近端极。文献报道仅有少数患者愈合率在80%至100%之间。
带血管蒂皮质松质骨和骨软骨内侧滑车瓣均改善了难愈性舟骨不愈合的治疗选择。到目前为止，仅发表了少数患者的结果。因此，当有合理数量患者的长期结果时，才能进行最终评估。
