{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T13:38:53Z","timestamp":1789220333035,"version":"build-2803163510"},"reference-count":33,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Handchir Mikrochir Plast Chir"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n          Hintergrund\/Ziel Vaskularisierte Transplantate von der medialen Femurkondyle werden in unserer Klinik seit 2008\u2005in gro\u00dfem Umfang zur Sanierung komplexer Skaphoidpseudarthrosen eingesetzt. Ziel der Arbeit ist eine Bilanz der Ergebnisse.<\/jats:p><jats:p>\n          Patienten und Methoden Bis Ende 2019 wurde bei 287\u2005Patienten eine Skaphoidrekonstruktion unter Verwendung eines mikrovaskul\u00e4r angeschlossenen Knochentransplantates, 158-mal mit einem kortikospongi\u00f6sen und 129-mal mit osteochondralen Transplantat von der medialen Femurkondyle, durchgef\u00fchrt. 28 von insgesamt 42\u2005Patienten mit kortikospongi\u00f6ser Rekonstruktion aus dem Zeitraum von September 2008 bis Dezember 2010 konnten durchschnittlich 6,1\u2005Jahre postoperativ und 44 von insgesamt 76\u2005Patienten mit osteochondralem Ersatz des proximalen Kahnbeinpoles aus den Jahren 2011 bis 2016 konnten durchschnittlich 44\u2005Monate postoperativ nachuntersucht werden. Neben klinischen Parametern und R\u00f6ntgenaufnahmen wurde der DASH-Score und der modifizierte Mayo-Wrist-Score (MMWS) erhoben. Zus\u00e4tzlich werden relevante Erfahrungen der Autoren aus dem gesamten Zeitraum \u2013 notwendigerweise ohne Quantifizierung \u2013 berichtet.<\/jats:p><jats:p>\n          Ergebnisse Bei den kortikospongi\u00f6sen Rekonstruktionen betrug die kn\u00f6cherne Ausheilungsrate 69\u2005%, bei 9,5\u2005% erfolgten Rettungseingriffen. Der DASH-Score lag bei den 28\u2005Patienten im Mittel bei 11, der MMWS bei 83\u2005Punkten. F\u00fcr Streckung\/Beugung wurden durchschnittlich 86\u00b0 und f\u00fcr die Kraft 89\u2005% der unverletzten Gegenseite gemessen. Beim osteochondralen Polersatz betrug die vollst\u00e4ndige kn\u00f6cherne Ausheilungsrate 80\u2005%, die partielle 5\u2005%; bei 11\u2005% war eine Rettungsoperation erforderlich. Der DASH-Score lag im Mittel bei 15, der MMWS bei 80\u2005Punkten. F\u00fcr Streckung\/Beugung wurden im Mittel 90\u00b0 und f\u00fcr die Kraft 81\u2005% der Gegenseite gemessen. Neben eingriffsspezifischen Komplikationen wie Stielossifikationen erwies sich die Wiederherstellung der Form des Skaphoids und der karpalen Stabilit\u00e4t in Abh\u00e4ngigkeit von der Komplexit\u00e4t des Ausgangsbefundes als Kernproblem. Eine Kl\u00e4rung der Ursachen der persistierenden Pseudarthrosen war nicht m\u00f6glich.<\/jats:p><jats:p>\n          Schlussfolgerung Gro\u00dfartigen M\u00f6glichkeiten stehen relevante Risiken in Abh\u00e4ngigkeit von der Komplexit\u00e4t des Ausgangsbefundes gegen\u00fcber. Eine umfassende Aufkl\u00e4rung ist zwingend, so dass geeignete Patienten sich mit realistischen Erwartungen f\u00fcr diesen Eingriff entscheiden k\u00f6nnen.<\/jats:p>","DOI":"10.1055\/a-1250-8026","type":"journal-article","created":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T22:35:12Z","timestamp":1601418912000},"page":"425-434","source":"Crossref","is-referenced-by-count":6,"title":["Kahnbeinpseudarthrose: Erfahrungen aus mehr als 280 Rekonstruktionen mit einem vaskularisierten Knochenblock aus der medialen Femurkondyle"],"prefix":"10.1055","volume":"52","author":[{"given":"Karlheinz","family":"Kalb","sequence":"additional","affiliation":[{"name":"Rh\u00f6n-Klinikum AG, Klinik f\u00fcr Handchirurgie"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Pillukat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e4rbel","family":"Jonke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelie","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"van Schoonhoven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Josef","family":"Prommersberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,9,29]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.hcl.2019.03.005","article-title":"Does Anyone Need a Vascularized Graft?","volume":"35","author":"S K Rancy","year":"2019","journal-title":"Hand Clin"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.hcl.2019.03.004","article-title":"The Role of Vascularized Bone Grafting in Scaphoid Nonunion","volume":"35","author":"N M Sgromolo","year":"2019","journal-title":"Hand Clin"},{"key":"ref3","first-page":"277","volume-title":"Vascularized Versus Nonvascularized Bone Grafts","author":"R Arora","year":"2018"},{"issue":"S 02","key":"ref4","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2106\/JBJS.I.00444","article-title":"Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. 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