1、2伸肌间室支持带上动脉桡骨瓣治疗舟骨骨不连的数字解剖及疗效分析

doi:10.13418/j.issn.1001-165x.2021.02.017

摘要/Abstract

摘要： 目的　探讨1、2伸肌间室支持带上动脉（the first and second intercompartmental supraretinacular artery，1，2 ICSRA）桡骨瓣治疗舟骨骨不连的可行性及疗效。方法　收集47例正常人腕关节CT数据，分别测量桡骨茎突尖端到舟骨长轴近极及远极距离，并与1，2 ICRSA血管蒂的长度进行对比，分析1，2 ICSRA桡骨瓣治疗舟骨骨不连的可行性。对23例舟骨骨不连患者实施1，2 ICSRA桡骨瓣结合Herbert钉内固定手术治疗，随访患者骨折愈合情况；采用Cooney腕关节评分评估患者局部症状和功能。结果　桡骨茎突尖端到舟骨长轴近极和远极距离分别为（15.66±1.89）mm和（17.07±1.60）mm，均小于1，2 ICSRA血管蒂长度。23例患者术后舟骨均获得愈合；随访时间（51.08±11.30）月，末次随访时21例患者腕关节疼痛感消失，2例患者重体力劳动时有轻微疼痛，但症状较术前得到明显改善；Cooney腕关节评分优20例，良3例，从术前（62.39±7.21）分提高至术后（92.39±4.23）分，差异有统计学意义（t=17.213，P=0）。结论　1，2 ICSRA桡骨瓣长度足以覆盖舟骨任何部位，该方法治疗舟骨骨不连具备可行性且疗效肯定。

关键词: , 1、2伸肌间室支持带上动脉；　桡骨瓣；　舟骨骨不连；　数字解剖

Abstract: Objective　To investigate the feasibility and evaluate the clinical efficacy of reconstructing scaphoid nonunion using a first and second intercompartmental supraretinacular artery (1,2 ICSRA) vascularized graft.　Methods 　The CT data of 47 patients with normal wrist joint were collected, and the distance from the tip of styloid of radius to the distal and proximal poles of the long axis of scaphoid were measured and compared with the length of vascular pedicle of 1,2 ICSRA to analyze the feasibility of 1,2 ICSRA vascularized graft for reconstruction of scaphoid nonunion. Twenty-three patients with scaphoid nonunion were treated with 1,2 ICSRA vascularized graft and Herbert screw internal fixation, and the healing of the fracture of patients were followed up and the postoperative efficacy of patients were evaluated by Cooney wrist score.　Results　The average distance from the tip of styloid radius to the proximal and distal poles of the long axis of scaphoid were (15.66±1.89) mm and (17.07±1.60) mm, respectively, which were much less than the length of vascular pedicle of 1,2 ICSRA. The mean follow-up duration was（51.08±11.30）months after the surgery for 23 cases, and bone union was achieved in all patients. At the last follow-up, the pain of wrist completely disappeared in 21 cases, and 2 cases felt slightly pain when they overworked, but the symptom of these patients were significantly improved. Cooney wrist score improved significantly from (62.39±7.21) points before the operation to（92.39±4.23）points at the last postoperative visit, and the difference was statistically significant (t=17.213，P=0). According to Cooney wrist score, the results were rated as excellent in 20 cases, good in 3 cases.　Conclusions 　1,2 ICSRA vascularized graft can cover any part of scaphoid, so this method is feasible. 1,2 ICSRA vascularized graft is an effective treatment for patients with scaphoid nonunion.

Key words: 1,2 Intercompartmental supraretinacular artery, 　Vascularized graft；　Scaphoid nonunion, 　Digital anatomy

中图分类号:

R641
R323.71

吕静, 刘立宏, 魏建伟, 董忠根, 陈宇飞. 1、2伸肌间室支持带上动脉桡骨瓣治疗舟骨骨不连的数字解剖及疗效分析[J]. 中国临床解剖学杂志, 2021, 39(2): 207-210.

Lv Jing, Liu Lihong, WEI Jianwei, Dong Zhonggen, Chen Yufei. Digital anatomical and clinical study on the reconstruction of scaphoid nonunion with 1，2 intercompartmental supraretinacular artery vascularized graft[J]. Chinese Journal of Clinical Anatomy, 2021, 39(2): 207-210.

参考文献 16

[1]	Borges CS, Ruschel PH, Pignataro MB. Scaphoid reconstruction[J]. Orthop Clin North Am, 2020, 51 (1): 65-76. DOI: 10.1016/j.ocl.2019.08.010.
[2]	Bervian MR, Ribak S, Livani B. Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery: diagnosis of scaphoid pseudarthrosis[J]. Int Orthop, 2015, 39(1): 67-72. DOI: 10.1007/s00264-014-2579-4.
[3]	Hirche C, Heffinger C, Xiong LY, et al. The 1, 2-intercompartmental supraretinacular artery vascularized bone graft for scaphoid nonunion: management and clinical outcome[J]. J Hand Surg Am, 2014, 39(3): 423-429. DOI: 10.1016/j.jhsa.2013.10.028.
[4]	Pulos N, Kollitz KM, Bishop AT, et al. Free vascularized medial femoral condyle bone graft after failed scaphoid nonunion surgery[J]. J Bone Joint Surg Am, 2018, 100(16): 1379-1386. DOI: 10.2106/JBJS.17.00955.
[5]	Lee SK, Park JS, Choy WS. Scaphoid fracture nonunion treated with pronator quadratus pedicled vascularized bone graft and headless compression screw[J]. Ann Plast Surg, 2015, 74(6): 665-671.DOI: 10.1097/SAP.0000000000000025.
[6]	Heinzelmann AD, Archer G, Bindra RR. Anthropometry of the human scaphoid[J]. J Hand Surg Am, 2007, 32(7): 1005-1008. DOI: 10.1016/j.jhsa.2007.05.030.
[7]	Lee KW, Bae JY, Seo DK, et al. Measurement of carpal alignment indices using 3-dimensional computed tomography[J]. J Hand Surg Am, 2018, 43(8): 771.e1-771.e7. DOI: 10.1016/j.jhsa.2018.01.003.
[8]	Cooney WP, Bussey R, Dobyns JH, et al. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist[J]. Clin Orthop Relat Res, 1987, 2(14): 136-147. PMID: 3791735.
[9]	Large TM, Adams MR, Loeffler BJ, et al. Posttraumatic avascular necrosis after proximal femur, proximal humerus, talar neck, and scaphoid fractures[J]. J Am Acad Orthop Surg, 2019, 27(21): 794-805. DOI: 10.5435/JAAOS-D-18-00225.
[10]	Werdin F, Jaminet P, Naegele B, et al. Reconstruction of scaphoid nonunion fractures of the proximal one third with a vascularized bone graft from the distal radius[J]. Eplasty, 2014, 14: e24. PMID: 25165493.
[11]	Pinder RM, Brkljac M, Rix L, et al. Treatment of scaphoid nonunion: a systematic review of the existing evidence[J]. J Hand Surg Am, 2015, 40(9): 1797-1805. DOI: 10.1016/j.jhsa.2015.05.003.
[12]	Zaidemberg C, Siebert JW, Angrigiani C, et al. A new vascularized bone graft for scaphoid nonunion[J]. J Hand Surg Am, 1991, 16(3): 474-478. DOI: 10.1016/0363-5023(91)90017-6.
[13]	Sheetz KK, Bishop AT, Berger RA. The arterial blood supply of the distal radius and ulna and its potential use in vascularized pedicled bone grafts[J]. J Hand Surg Am, 1995, 20(6): 902-914. DOI: 10.1016/S0363-5023(05)80136-4.
[14]	Tsumura T, Matsumoto T, Matsushita M, et al. Correction of humpback deformities in patients with scaphoid nonunion using 1, 2-intercompartmental supraretinacular artery pedicled vascularized bone grafting with a dorsoradial approach[J]. J Hand Surg Am, 2020, 45(2): 160.e1-160.e8. DOI: 10.1016/j.jhsa.2019.06.003.
[15]	Waitayawinyu T, Robertson C, Chin SH, et al. The detailed anatomy of the 1, 2 intercompartmental supraretinacular artery for vascularized bone grafting of scaphoid nonunion[J]. J Hand Surg Am, 2008, 33(2): 168-174. DOI: 10.1016/j.jhsa.2007.08.021.
[16]	Chaves C, Asmar G, Falcone MO. Anterior rerouting of the 1, 2 intercompartmental supraretinacular artery-based bone graft for scaphoid non-union: an anatomical study[J]. J Hand Surg Eur Vol, 2020, 45(2), 193-195. DOI: 10.1177/1753193419876900.