Treatment of refractory scaphoid fracture nonunion with computed tomography angiography combined with color Doppler ultrasonography assisted distal femoral medial condylar bone flap
10.3760/cma.j.cn114453-20231023-00101
- VernacularTitle:CT血管成像联合彩色多普勒超声设计游离股骨内侧髁骨瓣治疗难治性手舟骨骨折不愈合
- Author:
Wenhua GAO
1
;
Shuming ZHAO
;
Lu ZHANG
;
Dong LI
;
Anwei FAN
Author Information
1. 华北医疗健康集团邢台总医院骨三科，邢台 054000
- Keywords:
Scaphoid bone;
Fractures, ununited;
Ultrasonography, Doppler, color;
Computed tomography angiography;
Medial femoral condylar flap
- From:
Chinese Journal of Plastic Surgery
2023;39(12):333-340
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the surgical method of preoperative computed tomography angiography (CTA) combined with color Doppler ultrasonography (CDU) vascular localization assisted by downstream vascularized medial femoral condylar bone flap and its clinical effect in the treatment of refractory scaphoid fracture nonunion.Methods:Retrospective analysis of case data from January 2018 to June 2022 in the Department of Orthopedics at Xingtai General Hospital of North China Medical and Health Group, using a free medial femoral condylar bone flap with descending knee artery as the blood supply to repair old fractures of the scaphoid bone with bone damage in deceased patients. Prior to surgery, CTA combined with CDU technology was used to locate the descending knee artery, and the medial femoral condylar bone flap was designed based on the localization result and bone defects. Follow up was conducted using outpatient and telephone method . The degree of wrist pain was evaluated using Visual Analog Scale (VAS) , wrist function was evaluated using the improved Mayo scoring method , degree of scaphoid arch back deformity was evaluated based on the angle of the scaphoid bone, and stability between the carpal bones was evaluated based on the angle of the scaphoid moon. The normal distribution metric data is represented as Mean±SD, and paired sample t-tests are used to compare the preoperative CDU measurement and the actual intraoperative measurement of the vessel diameter at the origin of the descending knee artery, as well as the distance to the inferior edge of the medial femoral condyle. The VAS score for pain before and after surgery, the Mayo score for wrist function, wrist grip strength, range of motion, scaphoid angle, and scaphoid angle are also compared. Results:A total of 12 patients were included, including 9 males and 3 females; age range from 23 to 56 years old, with an average of 36 years old. There were 7 cases of right side fractures, 5 cases of left side fractures, 8 cases of scaphoid waist fractures, and 4 cases of proximal pole fractures. There was no difference between the preoperative CDU location and the actual vessel diameter at the origin of the descending geniculate artery [ (1.7±0.5 ) mm vs. (1.8±0.7) mm] and the distance to the inferior border of the medial femoral condyle [ (11.9±2.1) cm vs. (12.1±1.9) cm]. Statistical significance ( P>0.05) . All patients were followed up after the operation, the specific time ranged from 6 months to 2 years, with an average of 13 months. The X-ray films showed that the scaphoid bone healed in all patients after operation, and the average healing time was 15 weeks. After 6 months of follow-up, the VAS scores (3.7±0.9 vs. 0.5±0.1) , Mayo scores (46.1±3.8 vs. 86.2±6.1) , scapholunar angle [ (65.3±4.1) ° vs. (47.9±3.5) °] , scaphoid angle were compared before and after surgery[ (37.1±3.9) ° vs. (22.8±2.3) °] , wrist flexion and extension range of motion [ (79.0± 11.7) ° vs. (118.5±15.8) °] , grip strength [ (6.7±4.6) kg vs. (26.1±5.3) kg] , the differences were statistically significant (all P <0.05 ) . Conclusions:The free medial femoral condyle bone flap with a vascular pedicle is one of the ideal method to repair the old navicular fracture with osteonecrosis. The preoperative vascular positioning technique effectively guides the design and cutting of the bone flap and ensures fast and accurate operation during the operation.
