Die Behandlung der avaskulären Kahnbeinpseudarthrose: gefäßgestielter Knochenspan vom Beckenkamm oder vom medialen Femurkondyl?

Zusammenfassung

Die Behandlung von Kahnbeinpseudarthrosen ist nach wie vor eine Herausforderung für den behandelnden Handchirurgen – im Speziellen bei avaskulären, proximalen Kahnbeinpseudarthrosen oder vorangegangenen fehlgeschlagenen Operationen. Unterschiedliche operative Verfahren wurden etabliert und basieren auf der Rekonstruktion der korrekten Anatomie des Kahnbeins, welche einerseits Stabilität bietet und andererseits eine ausreichende Durchblutung wiederherstellt. Das Behandlungsspektrum reicht von avaskulären bis hin zu freien, gefäßgestielten Spaninterponaten. Die beiden am häufigsten verwendeten freien vaskularisierten Knochenspäne stammen vom Beckenkamm und vom medialen Femurkondyl. Der Femurkondylenspan zeigt eine konstantere Gefäßanatomie, geringere Hebemorbidität und höherer Heilungsrate im Vergleich zum Beckenkammspan. Zudem ist der Span technisch einfacher zu heben und kann sowohl als kortikospongiöser, wie auch osteochondraler Span gehoben werden. In Summe der Vorteile kommen wir zu dem Schluss, dass die Versorgung der Kahnbeinpseudarthrose bei avaskulärem proximalen Pol mittels gefäßgestieltem Femurkondylenspan die Methode unserer Wahl ist.

Abstract

Treatment of scaphoid non-unions is still challenging for responsible hand surgeons, especially in cases of avascular proximal pole non-unions or failed prior surgeries. Several surgical procedures treating scaphoid non-unions have been established. These aim to restore correct anatomy to provide stability and adequate blood flow. Treatment options range from avascular to free, vascularized bone grafts. The two most used free vascularized bone grafts derive from the iliac crest and the medial femoral condyle. The vascular anatomy of the medial femoral condyle graft is more constant, the donor site morbidity lower and the healing rate higher in comparison to the iliac crest graft. It is easier to harvest the femoral condyle graft and additionally, it can be harvested as a cortico-cancellous or osteochondral graft. Looking at all advantage, we come to the conclusion that the free vascularized medial femoral condyle graft is our method of choice for the treatment of a avascular proximal pole non-union of the scaphoid.

Schlüsselwörter

Kahnbein - Pseudoarthrose - freier Knochenspan - vaskularisierter Beckenspan - vaskularisierter Femurspan

Key words

Scaphoid - non-union - free bone graft - vascularized iliac bone graft - vascularized femur bone graft

Publication History

Received: 07 September 2020

Accepted: 08 September 2020

Article published online:
29 September 2020

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