旋前方肌起点松解对旋前方肌带蒂骨移植治疗舟骨不愈合患者临床疗效的影响
The Impact of Pronator Quadratus Origin Release on the Clinical Outcomes of Scaphoid Nonunion Patients Treated with Pronator Quadratus Pedicled Bone Grafts.
作者信息
Heydar Ahmed Majid, Kürklü Mustafa
机构信息
Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan.
Orthopedic and Traumatology Clinic, Memorial Bahçelievler Hospital, Bahçelievler Merkez, Adnan Kahveci Blv. No: 227, 34180 İstanbul, Turkey.
出版信息
J Clin Med. 2024 Aug 30;13(17):5157. doi: 10.3390/jcm13175157.
: A pronator quadratus pedicled bone graft (PQPBG) is a distal radius volar vascularized bone graft used not only for avascular necrosis of the lunate but also for scaphoid nonunion. Despite its potency and its possession of a muscular shield, this vascularized graft has a disadvantage in that the potential shortness of the muscular leash may limit the distal transfer of the bone graft. Releasing of the pronator quadratus (PQ) ulnar origin was used to enhance the distal mobility of the graft. We aimed to investigate the effect of a PQ release on the surgical outcomes of scaphoid nonunions that were operated on with the PQPBG technique. : Patients with scaphoid nonunion that were treated with PQPBG from 2009 to 2020 were reviewed. Patient demographic characteristics, surgical notes, physical examinations, and radiological evaluation data were collected. Wrist range of motion, grip strength, modified Mayo wrist score, and Quick-DASH score were used to evaluate the outcomes. The included patients were divided into two groups based on the origin release status of their PQ, i.e., with and without release. : This study included 37 patients, 17 of whom underwent a PQ release and 20 of whom did not. The failure rates for the two groups were one and four patients, respectively, and there was no significant difference between them ( = 0.11). The postoperative mean wrist extension in the patients with a PQ release was significantly greater than that in the patients without a release (43.5 ± 6.8 vs. 36.5 ± 7.7, = 0.0038). Although wrist flexion, ulnar deviation, radial deviation, mean outcome assessment scores, and grip strength were greater in the patients with a PQ release than in those without, no statistically significant intergroup differences were observed ( > 0.05). : The PQPBG technique is a viable option for achieving bony union in patients with scaphoid nonunion, but it results in the postoperative restriction of wrist extension. PQ release during a graft transfer may have a favorable effect on both bone union and clinical outcomes.
旋前方肌蒂骨移植术(PQPBG)是一种桡骨远端掌侧带血管蒂的骨移植术,不仅用于月骨缺血性坏死,也用于舟骨不愈合。尽管这种带血管蒂移植术效果显著且有肌肉保护,但存在一个缺点,即肌肉蒂可能较短,这可能会限制骨移植的远端转移。通过松解旋前方肌(PQ)的尺侧起点来增强移植骨的远端活动度。我们旨在研究PQ松解对采用PQPBG技术治疗舟骨不愈合手术效果的影响。
回顾了2009年至2020年采用PQPBG治疗的舟骨不愈合患者。收集患者的人口统计学特征、手术记录、体格检查和影像学评估数据。采用腕关节活动范围、握力、改良梅奥腕关节评分和Quick-DASH评分来评估治疗效果。根据PQ的起点松解情况,将纳入的患者分为两组,即松解组和未松解组。
本研究共纳入37例患者,其中17例行PQ松解,20例未行松解。两组的失败率分别为1例和4例,两组之间无显著差异(P = 0.11)。PQ松解组患者术后平均腕关节背伸角度显著大于未松解组(43.5±6.8°对36.5±7.7°,P = 0.0038)。尽管PQ松解组患者的腕关节掌屈、尺偏、桡偏、平均疗效评估得分和握力均高于未松解组,但组间差异无统计学意义(P>0.05)。
PQPBG技术是实现舟骨不愈合患者骨愈合的可行选择,但会导致术后腕关节背伸受限。在移植过程中进行PQ松解可能对骨愈合和临床疗效都有积极影响。