| Objective:1.To provide anatomical basis for lateral humeral condylar bone graft transplantation based on the radial collateral blood vessels in the treatment of scaphoid nonunion.2.To study the feasibility and clinical efficacy of lateral humeral condylar bone graft transplantation based on the radial collateral blood vessels in the treatment of scaphoid nonunion.Methods:Four adult upper limb specimens(a total of 8 upper limb specimens)with arterial perfusion of Latex-carboxymethylcellulose-lead oxide contrast filler were selected for high-resolution CT scanning and the digital anatomical model of the vascularized lateral humeral condylar bone graft was reconstructed with Mimics 21.0 software.The anatomical parameters related to the radial collateral vascular pedicle required for lateral humeral condylar bone graft transplantation were measured and compared on the gross specimen and digital model,including the outer diameter of the origin of the posterior branch of the radial collateral artery,the distance from the origin of the posterior branch of the radial collateral artery to the apex of the lateral epicondyle of the humerus,the outer diameter of the origin of the radial collateral artery,and the distance from the origin of the radial collateral artery to the apex of the lateral epicondyle of the humerus.Based on the radial collateral artery and the periosteal vascular network of the lateral condyle of humerus,the lateral humeral condylar bone graft was designed to treat scaphoid nonunion.Nine patients with scaphoid nonunion were treated in from September 2019 to January 2021.All patients were male.The average age was 22 years ranging from 12 to 39 years.Eight nonunions occurred in the waist area,the other one case was proximal 1/3nonunion.All nonunions were with avascular necrosis at the proximal pole of the scaphoid.Free vascularized bone graft was transferred to the scaphoid.The nutrient artery was anastomosed with the dorsal carpal branch of the radial artery,and the accompanying vein was anastomosed with the accompanying vein of the radial artery.The plaster cast was used routinely for 4 weeks postoperatively.Bone healing was evaluated with the X-ray demonstrations.A functional evaluation was performed six months after operation using the VAS scale,Quick DASH(Disabilities of the Arm,Shoulder and Hand)Outcome Measure and PRWE(Patient-Rated Wrist Evaluation)scoring system.Results:The digital anatomical model of the vascularized humeral flap was successfully established,and the measurement results on the threedimensional model showed that the average outer diameter of the origin of the posterior branch of the radial collateral artery of the 8 specimens was(1.99±0.28)mm,the average distance from the origin of the posterior branch of the radial collateral artery to the apex of the lateral epicondyle of the humerus is(6.40±1.61)cm,the average outer diameter of the origin of the radial collateral artery is(3.09±0.62)mm and the average distance from the origin of the radial collateral artery to the vertex of the lateral epicondyle of the humerus is(18.69±1.66)cm.the measurement results on cadaver specimens showed that the average outer diameter of the origin of the posterior branch of the radial collateral artery was(1.20±0.27)mm,the average distance from the origin of the posterior branch of the radial collateral artery to the vertex of the lateral epicondyle of the humerus was(6.08±0.97)cm,the average outer diameter of the origin of the collateral artery was(1.80±0.19)mm,the average distance from the origin of the radial collateral artery to the apex of the lateral epicondyle of the humerus was(18.66±1.54)cm and the average outer diameter of the posterior branch of the radial collateral artery at the proximal 2.5 cm where it entered the bone was(0.91±0.29)mm.The mean paired samples t-test was used to compare the measurement results of the cadaver specimen and the digital model.According to the α=0.05 level,the group of the distance from the origin of the posterior branch of the radial collateral artery to the apex of the lateral epicondyle of the humerus and the group of distance from the starting point of the radial collateral artery to the apex of the lateral epicondyle of the humerus P >0.05,which can’t judge the statistical difference.The group of outer diameters at the origin of the radial collateral artery and the group of outer diameters at the origin of the posterior branch of the radial collateral artery had a P <0.05,and the difference was statistically significant.All of the patients were followed for a mean of 21months(15～ 30 months).Union was achieved in all 9 patients at an average of 14 weeks(11～20 weeks)after surgery.In the last follow-up,the average palmar flexion,dorsal extension,radial deviation,and ulnar deviation of the affected wrist joint were(56.1±9.6)°,(56.1±10.5)°,(10.6±6.3)°,and(22.2±6.2)°,respectively,which reached 79.0%,82.1%,59.4%,72.8% of the average range of motion of the unaffected side respectively;the average grip strength of the affected side was(35.2±11.2)kg,which was equivalent to 81.3% of the average grip strength of the healthy side;The average VAS score of wrist pain was 1.0±0.5,the average Quick DASH score was9.6±3.8 and the average PRWE score was 12.8±2.9.Conclusion:1.The length and outer diameter of the vascular pedicle of the radial collateral artery are suitable,the anatomy of the lateral epicondyle of the humerus is constant,the vascular pedicle of the radial collateral artery has the anatomical basis for the preparation of vascularized humeral flaps.Digital anatomy can be applied to the measurement of vascular pedicle length but should not applied to the diameter of micro vessels.2.Lateral epicondyle bone flap grafting with radial collateral vessels has constant anatomy,abundant blood supply,simple excision,fast bone healing,good wrist joint function recovery,few complications and other advantages.It is an effective method for the treatment of scaphoid nonunion. |
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