Bartelmann U, Kalb K, Schmitt R, Fröhner S
Klinik für Handchirurgie, Abteilung II, Rhön-Klinikum, Bad Neustadt/Saale.
Handchir Mikrochir Plast Chir. 2001 Nov;33(6):365-78. doi: 10.1055/s-2001-19454.
In the literature little is to be found concerning diagnosis and differential diagnosis of Kienböck's disease. Because of technical development in radiological imaging, we now possess very detailed pictures. However, there are many radiological findings within the lunate bone, which can be misinterpreted as Kienböck's disease. Pathological findings of the lunate bone are demonstrated, which are not Kienböck's disease. These findings were compared to different stages of Kienböck's disease and identified. The early stages of Kienböck's disease show changes especially in the MRI, which are very similar to acute bone bruise, ulnar impaction syndrome, synovialitis or gout. Vessel tubes or an intraosseous ganglion can be mistaken for Kienböck's disease. In the late stages of Kienböck's disease, it can be difficult to differentiate this from pseudarthrosis of the lunate bone. The differentiation between Kienböck's disease and other pathological findings is at times very difficult--even with MRI. However, sometimes diagnosis can only be verified by MRI. We therefore suggest that Kienböck's disease must be correctly diagnosed with help of the MRI before commencing with any therapeutic steps.
关于月骨无菌性坏死的诊断和鉴别诊断，在文献中鲜有发现。由于放射影像学技术的发展，我们现在拥有非常详细的影像。然而，月骨内有许多放射学表现，可能会被误诊为月骨无菌性坏死。本文展示了月骨的病理表现，但并非月骨无菌性坏死。将这些表现与月骨无菌性坏死的不同阶段进行比较并加以识别。月骨无菌性坏死的早期阶段，尤其是在磁共振成像（MRI）上显示出的变化，与急性骨挫伤、尺骨撞击综合征、滑膜炎或痛风非常相似。血管或骨内腱鞘囊肿可能会被误诊为月骨无菌性坏死。在月骨无菌性坏死的晚期，很难将其与月骨假关节相鉴别。月骨无菌性坏死与其他病理表现之间的鉴别有时非常困难——即使借助MRI也是如此。然而，有时诊断只能通过MRI来证实。因此，我们建议在开始任何治疗措施之前，必须借助MRI正确诊断月骨无菌性坏死。
