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。
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.
关键词
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1、2伸肌间室支持带上动脉； 桡骨瓣； 舟骨骨不连； 数字解剖
Key words
1,2 Intercompartmental supraretinacular artery /
Vascularized graft； Scaphoid nonunion /
Digital anatomy
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参考文献
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基金
湖南省自然科学基金（2019JJ40432）
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