CAJ | 학술논문

目的：探讨应用桡骨远端骨膜瓣逆行带蒂转移结合Herbert螺钉内固定治疗腕舟骨骨不连的疗效。方法回顾性分析2007年3月至2013年4月对21例腕舟骨骨不连患者采用桡骨远端骨膜瓣逆行带蒂转移结合Herbert螺钉内固定进行治疗。 X-线片显示腕舟骨腰部骨折骨不连16例，腕舟骨近端骨不连5例，切取桡骨骨膜瓣1.2cm×4.2cm。术后定期复查X-线片，随访骨折愈合时间、腕关节疼痛、腕关节活动度等情况。结果术后21例患者均获得随访，时间为8-20个月，平均10个月。骨折均达到骨性愈合，时间为3-8个月，平均为4个月，腕关节疼痛基本消失，腕关节功能参照Krimmer腕关节评分系统评定结果：优17例，良3例，可1例。结论应用带蒂桡骨远端骨膜瓣移位结合Herbert螺钉内固定治疗腕舟骨骨不连具有重建舟骨血运，促进骨折端再血管化及成骨，同时提供坚强有效内固定，提高该类骨折愈合率。
목적：탐토응용뇨골원단골막판역행대체전이결합Herbert라정내고정치료완주골골불련적료효。방법회고성분석2007년3월지2013년4월대21례완주골골불련환자채용뇨골원단골막판역행대체전이결합Herbert라정내고정진행치료。 X-선편현시완주골요부골절골불련16례，완주골근단골불련5례，절취뇨골골막판1.2cm×4.2cm。술후정기복사X-선편，수방골절유합시간、완관절동통、완관절활동도등정황。결과술후21례환자균획득수방，시간위8-20개월，평균10개월。골절균체도골성유합，시간위3-8개월，평균위4개월，완관절동통기본소실，완관절공능삼조Krimmer완관절평분계통평정결과：우17례，량3례，가1례。결론응용대체뇨골원단골막판이위결합Herbert라정내고정치료완주골골불련구유중건주골혈운，촉진골절단재혈관화급성골，동시제공견강유효내고정，제고해류골절유합솔。
Objective To investigate the clinical outcome reverse-flow vascularized bone graft from the dorsal distal radius and internal fixation with Herbert screw for the treatment of scaphoid nonunion. Methods Retrospectively analyse the materials of the scaphoid nonunion in my hospital,from March 2007 to April 2013,21 cases of scaphoid nonunion were involved. Open reduc-tion,reverse-flow vascularized bone graft from the dorsal distal radius and internal fixation with Herbert screw were done. X-ray shows 16 waist fracture and nonunion,5 proximal fracture and nonunion,Cut out radial periosteum graft 1.2cm×4.2cm. Regularly review the X-ray film after operation,and follow the situations as the fracture healing time,wrist joint pain、wrist joint activity,etc. Results All 21 patients were followed up after operation ranged from 8 to 20 months (for an average 10 months). The fractures were clinically healed ranged from 3 to 8 months (for an average 4 months),the wrist joint pains were almost disappeared. The wrist joint functions were evaluated according to Krimmer wrist joint evaluation system:17 were rated as excellent,3 as fine,1 as middle. Conclusion The treatment of scaphoid nonunion by stylectomy plus vascularized radial periosteum graft from the dorsal distal radius and internal fixation with Herbert screws,can rebuild the scaphoid blood supply,promote fracture end vascularization and osteogenesis,meanwhile provide strong valid fixation,raise the healing rate of this fracture.