Tanner Cary, Johnson Toby, Majors Alex, Hentz Vincent R, Husak Lisa, Walker Gallego Edward, Christ Brad, Hoekzema Nathan
1 Sierra Pacific Orthopedics Center, Fresno, CA, USA.
2 University of California, San Francisco, Fresno, CA, USA.
Hand (N Y). 2019 Jul;14(4):500-507. doi: 10.1177/1558944717751191. Epub 2018 Jan 22.
Vascularized periosteal flaps from the distal radius have been previously proposed. The purpose of this study was to investigate the vascularity and osteogenic potential of a vascularized volar distal radial periosteal flap for the treatment of scaphoid nonunion. In 5 fresh frozen cadavers, a rectangular periosteal flap was elevated from the distal radius with the pedicle just proximal to the watershed line. Latex dye was injected into the radial artery proximally and the vascularity of the flap characterized by microscopic evaluation. Patients with scaphoid nonunion were then treated with open reduction, internal fixation, and distal radius cancellous bone graft. Two groups of patients with midwaist nonunion scaphoid were then evaluated. The first group received the vascularized periosteal flap and the second group received a nonvascularized periosteal flap. A third group of proximal pole nonunions also received the vascularized flap. Cadaveric dissections revealed that all of the injected flaps demonstrated vascularity to the distal edge of the flap. Vascularized flaps formed visible bone on imaging in 55% of cases. None of the nonvascularized flaps formed visible bone. In group 1, 12/12 midwaist nonunions united. In group 2, union was achieved in 6/6 of patients who completed the follow-up. In group 3, 6/7 proximal pole fractures united. Previously proposed vascularized periosteal flaps from the distal radius appear to possess notable osteogenic potential that may be of interest to surgeons treating scaphoid nonunion.
此前有人提出采用来自桡骨远端的带血管蒂骨膜瓣。本研究的目的是探讨带血管蒂的桡骨远端掌侧骨膜瓣的血管分布及成骨潜力，用于治疗舟骨不愈合。在5具新鲜冷冻尸体上，从桡骨远端掀起一个矩形骨膜瓣，其蒂位于分水岭线近端。向近端的桡动脉注入乳胶染料，通过显微镜评估来确定骨膜瓣的血管分布情况。然后对舟骨不愈合患者进行切开复位、内固定及桡骨远端松质骨移植治疗。接着对两组舟骨腰部不愈合患者进行评估。第一组接受带血管蒂骨膜瓣，第二组接受不带血管蒂骨膜瓣。第三组舟骨近端不愈合患者也接受带血管蒂骨膜瓣治疗。尸体解剖显示，所有注入染料的骨膜瓣其远端边缘均有血管分布。带血管蒂骨膜瓣在55%的病例中在影像学上形成了可见骨。不带血管蒂骨膜瓣均未形成可见骨。在第一组中，12例腰部不愈合患者均实现了愈合。在第二组中，完成随访的6例患者均实现了愈合。在第三组中，7例近端骨折患者中有6例实现了愈合。此前提出的来自桡骨远端的带血管蒂骨膜瓣似乎具有显著的成骨潜力，这可能会引起治疗舟骨不愈合的外科医生的兴趣。
