Zusammenfassung
Skaphoidpseudarthrosen können in der Regel mittels Spongiosaplastiken oder avaskulären kortikospongiösen Spänen effektiv behandelt werden. Es gibt aber Patienten, bei denen die Perfusion des Skaphoids zusätzlich eingeschränkt ist. Hier handelt es sich um Patienten mit proximalen Frakturen und schlechter Perfusion des proximalen Pols sowie um Patienten nach erfolgloser Skaphoidosteosynthese mit gelockertem Osteosynthesematerial sowie fragmentiertem Knochen. Hier kann eine zusätzliche Revaskularisierung des Knochens mittels chirurgischer Angiogenese sinnvoll sein. Diese kann durch gestielte vaskularisierte Radiusspäne und auch freie vaskularisierte Knochentransplantate wie des freien osteoperiostalen Lappens vom medialen Femurkondylus erfolgen. In dieser Übersichtsarbeit werden diese Verfahren vorgestellt, das operative Vorgehen beschrieben und ein therapeutischer Algorithmus dargestellt, der eine therapeutische Leitlinie bieten soll, um dieses schwierige Patientengut strategisch sinnvoll zu behandeln.
Abstract
Treatment for scaphoid nonunion is mostly effective using avascular cancellous bone grafts; however, perfusion of the proximal pole of the scaphoid is compromised in some patients. These are patients suffering from proximal scaphoid fractures or patients who underwent previous attempts at scaphoid reconstruction with loose osteosynthesis material or multiple bone fragments. Revascularization of the scaphoid using surgical angiogenesis can be reasonable in these cases. Typical vascularized bone grafts for these procedures are pedicled bone grafts from the distal radius or free mircrovascular bone grafts, such as osteoperiosteal grafts from the medial femoral condyle. This review article summarizes this approach, describes the operative procedures and presents a treatment algorithm to facilitate a reasonable therapeutic strategy in these difficult clinical situations.
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T. Kremer, C. Hirche, L. Harhaus-Wähner, U. Kneser und B. Bickert geben an, dass kein Interessenkonflikt besteht.
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Kremer, T., Hirche, C., Harhaus-Wähner, L. et al. Der vaskularisierte Knochentransfer zur Therapie von Skaphoidpseudarthrosen. Obere Extremität 9, 252–259 (2014). https://doi.org/10.1007/s11678-014-0288-7
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DOI: https://doi.org/10.1007/s11678-014-0288-7