两种骨瓣移植治疗陈旧性舟骨骨折的比较

摘要

目的 比较采用桡动脉茎突返支骨瓣移植及游离膝降动脉骨瓣移植治疗陈旧性舟骨骨折的手术方法及疗效.方法 自2009年6月至2015年6月收治49例陈旧性舟骨骨折患者,22例采用内固定加桡动脉返支为蒂的桡骨茎突骨瓣移位治疗,27例采用内固定加膝降动脉为蒂的股骨内侧髁骨瓣游离移植治疗.比较两组的手术时间、骨折愈合时间及腕关节功能.结果 膝降动脉骨瓣组手术时间(186.00±26.48) min大于桡骨茎突骨瓣组(107.00±25.18)min,t=10.617,P＜0.001;但骨折愈合方面桡骨茎突骨瓣组所需时间(16.90±3.58)周长于膝降动脉骨瓣组(13.20±3.10)周,t=3.874,P＜0.001.术后6个月采用改良Mayo评分法评定腕关节功能,桡骨茎突骨瓣组优12例、良9例、可1例,平均87分;膝降动脉骨瓣组优12例、良13例、可1例、差1例,平均81分.两组间优良率差异无统计学意义.结论 桡动脉返支茎突骨瓣移植和膝降动脉骨瓣移植均是治疗舟骨骨折不愈合的有效方法.膝降动脉游离骨瓣移植者骨折愈合更快,但手术更加费时费力.%Objective To compare surgical procedure and clinical effects of bone flap transplantation vascularized by recurrent branch of the radial artery and by descending genicular artery in the treatment of old scaphoid fracture.Methods From June 2009 to June 2015,a total of 49 patients with old scaphoid fracture were retrospectively reviewed.22 cases were treated by internal fixation with transplantation of radial styloid bone flap pedicled on the recurrent branch of the radial artery,while the other 27cases by internal fixation with free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery.The operation time,fracture healing time and wrist function were compared between the two groups.Results The operation time of the descending genicular artery bone flap group (186.00±26.48) min was greater than that of the radial styloid bone flap group (107.00±25.18) min (t=10.617,P＜0.001).However,the fracture healing time of the radial styloid bone flap group (16.90±3.58) weeks was longer than that of the descending genicular artery bone flap group (13.20±3.10) weeks (t=3.874,P＜0.001).Modified Mayo wrist scoring system was used to evaluate the wrist function 6 months after the surgery.In the radial styloid bone flap group,the results were excellent in 12 cases,good in 9 cases,and fair in 1 case with the average score being 87.In the descending genicular artery bone flap group,the results were excellent in 12 cases,good in 13 cases,fair in 1 case,and poor in 1 ease with the average score being 81.There was no significant difference between the two groups.Conclusion Both of the surgical procedures are effective methods for treating old scaphoid fracture.The free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery is faster in fracture healing,but more time-consuming and demanding.