CAJ | 학술논문

目的介绍游离股骨内侧髁骨瓣移植的适应证和手术方法,及其治疗难治性舟骨骨折不愈合的初期随访结果.方法以膝降动脉及其发出的股骨内侧髁骨膜血管网为基础,设计股骨内侧髁游离骨瓣移植治疗10例难治性舟骨骨折不愈合.患者均为男性,年龄23～46岁,平均29岁.近极骨折5例,腰部骨折5例.伴驼背畸形4例,近极缺血性坏死4例.骨瓣移至舟骨处充填骨缺损后,将滋养动脉与桡动脉端侧吻合,伴行静脉与桡动脉伴行静脉端端吻合.术后管型石膏制动8周,根据X线表现评估骨折愈合情况.愈合标准是舟骨位、侧位、旋前、旋后45°斜位X线片上均有连续骨小梁通过骨折线.术后半年采用改良Mayo方法评估腕关节功能.结果所有患者均获随访,平均11(8～14)个月.10例患者骨折全部愈合,愈合时间平均12(8～16)周.腕关节功能:优3例,良6例,可1例.未出现严重并发症.结论吻合血管的游离股骨内侧髁骨瓣移植治疗难治性舟骨骨折不愈合的优点是骨块易于切取、易于修整而又不破坏血供,供区并发症少.骨瓣移植后愈合率高,愈合时间短,较传统方法有一定优势.
목적 개소유리고골내측과골판이식적괄응증화수술방법,급기치료난치성주골골절불유합적초기수방결과.방법 이슬강동맥급기발출적고골내측과골막혈관망위기출,설계고골내측과유리골판이식치료10례난치성주골골절불유합.환자균위남성,년령23～46세,평균29세.근겁골절5례,요부골절5례.반타배기형4례,근겁결혈성배사4례.골판이지주골처충전골결손후,장자양동맥여뇨동맥단측문합,반행정맥여뇨동맥반행정맥단단문합.술후관형석고제동8주,근거X선표현평고골절유합정황.유합표준시주골위、측위、선전、선후45°사위X선편상균유련속골소량통과골절선.술후반년채용개량Mayo방법평고완관절공능.결과 소유환자균획수방,평균11(8～14)개월.10례환자골절전부유합,유합시간평균12(8～16)주.완관절공능:우3례,량6례,가1례.미출현엄중병발증.결론 문합혈관적유리고골내측과골판이식치료난치성주골골절불유합적우점시골괴역우절취、역우수정이우불파배혈공,공구병발증소.골판이식후유합솔고,유합시간단,교전통방법유일정우세.
Objective To introduce the indications and operative procedure of a free-vascularized medial femoral condyle bone graft and the preliminary result with it in the treatment of refractory scaphoid nonunions.Methods The free medial femoral condyle bone grafting method was designed to deal with the refractory scaphoid nonunions on the basis of the anatomical features of articular branch of the descending genicular vessel and the superomedial genicular vessel.Ten patients with refractory scaphoid nonunion were treated in 2008.All patients were male.The average age was 29 years ranging from 23 to 46 years.Five non-unions occurred in the waist area,the other five cases were proximal pole nonunion.Four cases were associated with humpback deformity,and four were with avascular necrosis at the proximal pole of the scaphoid.Pedicled vascular bone graft was transferred to the scaphoid.An arteriotomy was made in the radi-al artery,and an end-to-side anastomosis was performed.A microvenous repair was then performed in an end-to-end fashion to a vena comitans.The plaster cast was used routinely for eight weeks postoperatively.Bone healing was evaluated with the X-ray demonstrations.Union was achieved when there was trabecular bridging of the distal and proximal fragments of the scaphoid on the scaphoid view,lateral view,semipronat-ed view and semisupinatod view.A functional evaluation was performed six months after operation using the modified Mayo wrist scoring system.Results The average follow-up period was 11 months(range from 8 to14 months).Bone union was achieved in all patients at an average of 12 weeks after surgery,ranging form 8to 16 weeks.The scores for overall outcome were excellent in 3 patients,good in 6,and fair in 1 patient.Conclusion A vascularized interposition graft from the medial femoral condyle is the recommended vascu-larized bone graft for the surgical treatment of refractory scaphoid waist nonunion.It has higher union rate and a shorter anion time with less morbidity at donor site,compared with the other methods.It is easy to harvest and shape without compromising its blood supply.It is an attractive alternative to the conventional vascularized bone grafting procedures.