CAJ | 학술논문

目的探讨以第一、二伸肌腱鞘支持带上动脉(1,2 ICSRA)为血管蒂的桡骨瓣带蒂逆行转移治疗舟骨骨不连的手术指征、技术和疗效.方法 2007年2月至2010年10月,我科对15例舟骨骨不连患者,应用以1,2 ICSRA为血管蒂的桡骨瓣远端蒂转移植骨内固定进行治疗.其中腰部骨不连9例,近端骨不连6例.9例伴有近端骨折块缺血性坏死；3例伴有舟状骨弓背畸形及嵌入体背伸不稳(DISI)；2例伴有桡骨茎突关节炎表现.所有病例均采用腕桡侧纵形切口,13例予以交叉克氏针内固定,2例行单枚Herbert螺钉附加1枚克氏针固定.12例将带血管蒂植骨块从舟骨背侧嵌插植入,3例将植骨块楔形修整后自舟骨掌侧植入.术后随访骨折愈合时间、腕痛、腕关节活动度及握力等情况.结果术后随访时间为6～ 21个月,平均13个月,2例失访.所有随访病例X线片显示舟骨均获得骨性愈合,平均愈合时间为14.2周.所有患者腕痛消失,腕关节屈曲(59.92±4.82)°,背伸(49.73±4.58)°.根据改良的Mayo腕关节功能评分标准评定:优9例,良2例,可2例；优良率为84.6％.结论以1,2 ICSRA为血管蒂的桡骨瓣逆行转移植骨手术,能促进舟骨骨不连的愈合,特别对有近端骨块缺血性坏死的患者疗效显著.
목적 탐토이제일、이신기건초지지대상동맥(1,2 ICSRA)위혈관체적뇨골판대체역행전이치료주골골불련적수술지정、기술화료효.방법 2007년2월지2010년10월,아과대15례주골골불련환자,응용이1,2 ICSRA위혈관체적뇨골판원단체전이식골내고정진행치료.기중요부골불련9례,근단골불련6례.9례반유근단골절괴결혈성배사；3례반유주상골궁배기형급감입체배신불은(DISI)；2례반유뇨골경돌관절염표현.소유병례균채용완뇨측종형절구,13례여이교차극씨침내고정,2례행단매Herbert라정부가1매극씨침고정.12례장대혈관체식골괴종주골배측감삽식입,3례장식골괴설형수정후자주골장측식입.술후수방골절유합시간、완통、완관절활동도급악력등정황.결과 술후수방시간위6～ 21개월,평균13개월,2례실방.소유수방병례X선편현시주골균획득골성유합,평균유합시간위14.2주.소유환자완통소실,완관절굴곡(59.92±4.82)°,배신(49.73±4.58)°.근거개량적Mayo완관절공능평분표준평정:우9례,량2례,가2례；우량솔위84.6％.결론 이1,2 ICSRA위혈관체적뇨골판역행전이식골수술,능촉진주골골불련적유합,특별대유근단골괴결혈성배사적환자료효현저.
Objective To study the indication,techniques,and treatment outcomes of using a retrograde pedicled vascularized radius bone flap based on 1,2 intercompartmental supraretinacular artery ( 1,2ICSRA) to treat scaphoid nonunion.Methods Between February 2007 and October 2010,15 patients with established scaphoid nonunion were treated with open reduction and internal fixation in addition to a retograde pedicled vasculatized radius bone flap based on 1,2 ICSRA.Among these patients 9 had nonunion of the scaphoid waist and 6 had nonunion of the proximal pole of the scaphoid.9 patients were associated with avascular necrosis of the proximal fragments,3 with humpback deformity of the scaphoid and dorsal intercalated segment instability (DISI),and 2 with arthritis of radius styloid.In all cases a longitudinal incision was made through radial dorsum of the wrist.Bone graft was fixed with two cross Kirschner wires in 13 cases,and with one Herbert screw and one Kirschner wire in 2 cases.12 pedicled bone flaps were wedged in from the dorsum of the scaphoid,while 3 from the volar aspect of the scaphoid.Postoperative evaluation included the time to union,the range of motion of the wrist,pain relief and grip strength.Results Thirteen patients were follow-up and 2were lost.Duration of follow-up ranged from 6 to 21 months,with an average of 13 months.Union rate was 13 of 13 ( 100％ ) and the averaged union time was 14.2 weeks.All patients achieved complete pain relief.The flexion and extension of the wrist were (59.92±4.82)° and (49.73t±4.58)° respectively.The functional results were encouraging in all patients (9 excellent,2 good,and 2 fair),with an excellent and good rate of 84.6％,which were measured using the modified Mayo wrist score.Conclusion Retrograde pedicled vascularized radius bone flap based on 1,2 ICSRA can promote scaphoid union,especially for those patients associated with proximal pole avascular necrosis.