Salon A, Hémon C
Clinique de la main, 36 bis, rue Nicolo, 75116 Paris, France.
Chir Main. 2003 Jun;22(3):154-7. doi: 10.1016/s1297-3203(03)00040-4.
We present 2 cases of Kienböck's disease in which peri-lunate chondral lesions contra-indicated classical procedures such as proximal row carpectomy or 4 corner arthrodesis. A partial carpectomy provided us with an osteochondral graft, used to resurface the areas of chondral damage over the capitate or on the radius. The clinical and radiological result was stable at a follow-up of 3 and 6 years. In the first case, degenerative changes over the head of the capitate contra-indicated proximal row carpectomy. The lunate was removed and the proximal 2/3 of the scaphoid were shifted medially and fused in a "four-corner"-like arthrodesis. In the second case, the lunate fossa on the radius was damaged. The proximal row was excised and an osteochondral graft was harvested from the triquetrum. This was used to replace the lunate fossa on the radius. This new concept of a "carpal bank" has enabled us to extend the classical indications for proximal row carpectomy and four-corner arthrodesis. It makes it possible to withdraw the limits of conservative wrist surgery in Kienböck's disease and we believe this concept could also be extended to similar situations of localized chondral damage in small joints.
我们报告2例月骨无菌性坏死病例，其中月周软骨损伤使近端排腕骨切除术或四角融合术等传统手术成为禁忌。部分腕骨切除术为我们提供了一块骨软骨移植物，用于修复头状骨或桡骨上的软骨损伤区域。在3年和6年的随访中，临床和放射学结果稳定。在第一例中，头状骨头的退行性改变使近端排腕骨切除术成为禁忌。切除月骨，将舟骨近端2/3向内侧移位并融合成类似“四角”的融合术。在第二例中，桡骨的月骨窝受损。切除近端排腕骨，从三角骨获取一块骨软骨移植物，用于替代桡骨上的月骨窝。这种“腕骨库”的新概念使我们能够扩大近端排腕骨切除术和四角融合术的传统适应证。它使得在月骨无菌性坏死中放宽保守性腕关节手术的限制成为可能，我们相信这个概念也可以扩展到小关节局部软骨损伤的类似情况。
