Chan Andrea H W, Elhassan Bassem T, Suh Nina
Hand Clinic, Toronto Western Hospital, 399 Bathurst Street, East Wing 2nd Floor, Toronto, Ontario M5T 2S8, Canada.
Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
Hand Clin. 2019 Aug;35(3):287-294. doi: 10.1016/j.hcl.2019.03.007. Epub 2019 May 11.
Scaphoid proximal pole fractures remain a surgical challenge because of high propensity for nonunion, osteonecrosis, and ultimately carpal collapse. Options for management of nonsalvageable proximal pole fractures include non-vascularized bone grafts, vascularized pedicled bone grafts, free vascularized bone flaps, and rib cartilage grafts. The proximal pole of the hamate can also serve as a replacement arthroplasty in the setting of proximal pole scaphoid nonunions with collapse, bone loss, and/or osteonecrosis. This novel graft addresses shortcomings of other graft choices by providing a local structural autograft solution with minimal donor site morbidity, correcting carpal collapse, reconstructing the scapholunate ligament, and mitigating the need for microvascular anastomosis.
舟骨近端骨折仍然是一个手术挑战，因为其不愈合、骨坏死以及最终导致腕骨塌陷的可能性很高。对于无法挽救的近端骨折，处理选项包括非带血管骨移植、带血管蒂骨移植、游离带血管骨瓣和肋软骨移植。在舟骨近端骨折不愈合伴有塌陷、骨质丢失和/或骨坏死的情况下，钩骨近端也可作为替代关节成形术。这种新型移植通过提供一种局部结构自体移植解决方案，将供区并发症降至最低，纠正腕骨塌陷，重建舟月韧带，并减少微血管吻合的需求，从而解决了其他移植选择的缺点。
