Giusti Guilherme, Bishop Allen T, Shin Alexander Y
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic Health System, Eau Claire, WI.
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
J Hand Surg Am. 2019 May;44(5):423.e1-423.e6. doi: 10.1016/j.jhsa.2018.07.017. Epub 2018 Oct 6.
The purpose of this study was to radiographically evaluate scaphoid length and carpal parameters before and after reconstruction of nonunions with interposition vascularized medial femoral condyle (MFC) bone graft to determine if the scaphoid was overstuffed or if normal anatomy was restored and to determine the effect on ulnar carpal translocation when the volar radiocarpal ligaments were left unrepaired.
Thirty-nine patients with established scaphoid nonunions with carpal collapse were reconstructed by interposition vascularized MFC bone grafts without repair of the volar radiocarpal ligaments. Pre- and postoperative radiographs and computed tomography scans of the 39 patients were reviewed. The scaphoid length, capitate-ulnar distance ratio (CUDR), modified carpal height ratio (MCHR), radiolunate (RL) and scapholunate (SL) angles were measured before and 3 months after surgery. Thirteen of these patients had contralateral wrist radiographs that were used for analysis of scaphoid length restoration.
No significant changes were observed for CUDR and MCHR before and after surgery. The length of the scaphoid significantly improved after reconstruction from 21.9 ± 3.3 to 23.7 ± 3.4 mm on posteroanterior x-ray views and from 24.0 ± 2.2 to 27.7 ± 2.8 mm on lateral views. The RL and SL angles also changed significantly after surgery from 19.5° ± 13.5° to 4.1° ± 16.9° and from 67.5° ± 12.5° to 56.0° ± 12.5°, respectively. Regarding the 13 patients with contralateral x-rays, no differences were seen on CUDR, MCHR, or scaphoid length on posteroanterior x-ray views. However, the scaphoid length on lateral x-ray views increased from 23.1 ± 2.40 to 27.6 ± 2.78 mm and was significantly longer than the contralateral side by 9.6%. The RL and SL angles were restored and comparable with the contralateral side.
The use of vascularized MFC bone graft increased scaphoid length by 9.6% and restored normal carpal alignment. Despite the increased scaphoid length compared with the contralateral side, the lack of repair of the volar radiocarpal ligaments did not cause ulnar carpal translocation in short-term follow-up.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在通过影像学评估带血管蒂的内侧股骨髁（MFC）骨移植重建舟骨不愈合前后的舟骨长度和腕骨参数，以确定舟骨是否填充过度或正常解剖结构是否恢复，并确定在未修复掌侧桡腕韧带时对腕骨尺侧移位的影响。
39例已确诊的舟骨不愈合伴腕骨塌陷患者接受了带血管蒂的MFC骨移植重建，未修复掌侧桡腕韧带。回顾了这39例患者术前和术后的X线片及计算机断层扫描。测量了手术前和手术后3个月的舟骨长度、头状骨-尺骨距离比（CUDR）、改良腕骨高度比（MCHR）、桡月（RL）和舟月（SL）角。其中13例患者有对侧腕部X线片，用于分析舟骨长度恢复情况。
手术前后CUDR和MCHR无明显变化。重建后舟骨长度在正位X线片上从21.9±3.3mm显著增加到23.7±3.4mm，在侧位片上从24.0±2.2mm增加到27.7±2.8mm。术后RL和SL角也有显著变化，分别从19.5°±13.5°变为4.1°±16.9°，从67.5°±12.5°变为56.0°±12.5°。对于13例有对侧X线片的患者，正位X线片上的CUDR、MCHR或舟骨长度无差异。然而，侧位X线片上的舟骨长度从23.1±2.40mm增加到27.6±2.78mm，比另一侧显著长9.6%。RL和SL角恢复，与对侧相当。
使用带血管蒂的MFC骨移植使舟骨长度增加了9.6%，并恢复了正常的腕骨排列。尽管与对侧相比舟骨长度增加，但在短期随访中，未修复掌侧桡腕韧带并未导致腕骨尺侧移位。
研究类型/证据水平：治疗性IV级。
