Daecke Wolfgang, Lorenz Sebastian, Wieloch Peter, Jung Martin, Martini Abdul-Kader
Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg, Germany.
J Hand Surg Am. 2005 Sep;30(5):915-22. doi: 10.1016/j.jhsa.2005.03.019.
Little is known about the long-term results of vascularized bone transplantation for Kienböck's disease. This retrospective study investigated the long-term results of vascularized pisiform transfer.
We reviewed 23 patients to analyze results after vascularized pisiform transposition to a cored-out lunate for Lichtman stages II and III. Patients with ulnar-minus variance received additional radial shortening.
Pain improved in 20 of 23 patients. Range of motion increased significantly relative to preoperative values but was only 80% that of opposite side. Grip power was 84% of the contralateral hand. At follow-up evaluation the mean Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15.3 +/- 17.9 and the mean Cooney score was 82.4 +/- 10.0. Radiologically, out of 20 patients with preoperative x-rays Lichtman stage was unchanged in 11, improved in 3, and progressed in 6 patients. No patient showed radiologic signs of arthritis before surgery. At follow-up evaluation osteoarthritis was found in 7 of 22 patients. The majority of degenerative changes were of low grade and were seen at the radiocarpal joint.
The results show high patient satisfaction and good function after vascularized bone transplantation for Kienböck's disease. In the long term vascularized pisiform transfer prevented lunate collapse in 16 of 22 patients.
关于月骨无菌性坏死的带血管骨移植的长期结果了解甚少。这项回顾性研究调查了带血管豌豆骨转移术的长期结果。
我们回顾了23例患者，分析了将带血管豌豆骨转位至月骨空心部位治疗 Lichtman II期和III期疾病的结果。尺骨负变异的患者接受了额外的桡骨缩短术。
23例患者中有20例疼痛得到改善。相对于术前值，活动范围显著增加，但仅为对侧的80%。握力为对侧手的84%。在随访评估中，手臂、肩部和手部残疾问卷平均得分为15.3±17.9，Cooney平均得分为82.4±10.0。放射学检查方面，20例术前有X线片的患者中，11例Lichtman分期无变化，3例改善，6例进展。术前没有患者出现关节炎的放射学迹象。在随访评估中，22例患者中有7例发现骨关节炎。大多数退行性改变程度较轻，见于桡腕关节。
结果显示，月骨无菌性坏死带血管骨移植术后患者满意度高，功能良好。从长期来看，22例患者中有16例通过带血管豌豆骨转移术防止了月骨塌陷。
