Gong H S, Chung M S, Lee Y H, Lee S, Lee J O, Baek G H
Department of Orthopaedic Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
J Bone Joint Surg Br. 2006 May;88(5):623-8. doi: 10.1302/0301-620X.88B5.16888.
We have performed a form of lunate replacement arthroplasty, which included excision of the lunate and insertion of a vascularised radial bone flap wrapped in pronator quadratus, for stage IIIB or stage IV Kienböck's disease, in 41 patients who have been followed up for more than three years. All patients reported an improvement in their symptoms, and 20 of the 41 became free of pain after the operation. Extension and flexion of the wrist were increased by a mean of 9 degrees and 6 degrees , respectively (p < 0.05). The radioscaphoid angle and the carpal height ratio were not significantly changed and only minimal deterioration was observed due to degenerative change. The size, density or location of the inserted bone did not change with time. A vascularised radial bone flap wrapped in pronator quadratus can be a reliable treatment option for advanced Kienböck's disease, when the pedicled bone and muscle envelope acts as a stable spacer for the excised lunate.
我们对41例随访超过三年的ⅢB期或Ⅳ期月骨无菌性坏死患者进行了一种月骨置换关节成形术，该手术包括切除月骨并植入包裹旋前方肌的带血管蒂桡骨瓣。所有患者均报告症状有所改善，41例中有20例术后疼痛消失。腕关节背伸和掌屈分别平均增加了9度和6度（p<0.05）。桡舟角和腕骨高度比无明显变化，仅观察到因退变导致的轻微恶化。植入骨的大小、密度或位置未随时间改变。当带血管蒂的骨和肌肉包膜作为切除月骨的稳定间隔物时，包裹旋前方肌的带血管蒂桡骨瓣可成为晚期月骨无菌性坏死的可靠治疗选择。
