Tatebe Masahiro, Horii Emiko, Majima Masataka, Koh Shukuki, Nakamura Ryogo, Hirata Hitoshi
Department of Hand Surgery, Nagoya University School of Medicine, Showaku, Nagoya, Japan.
J Hand Surg Am. 2007 Nov;32(9):1343-7. doi: 10.1016/j.jhsa.2007.08.013.
Advanced Kienböck's disease often involves displaced fractures of the lunate; however, whether such fractures affect surgical outcomes remains unclear. The purpose of this study was to evaluate the results of radial osteotomy for Kienböck's disease with displaced fractures of the lunate and whether these fractures would achieve union.
We reviewed patients who had radial osteotomy for Kienböck's disease between 1975 and 2004. We included only displaced fractures of the lunate that were apparent on lateral radiography, and 31 patients (24 men, 7 women; mean age, 35 y) were then included in this study. Postoperative state of the lunate and clinical results were compared between cases of union and nonunion.
Preoperatively, mean flexion/extension arc was 76 degrees , and mean grip strength was 22 kg. Postoperatively, mean flexion/extension arc was 84 degrees , and mean grip strength was 30 kg. Radiography revealed fracture healing in 16 wrists. No significant differences between union and nonunion were noted in any assessed clinical items.
This study showed approximately 50% union after radial osteotomy. Fracture union did not affect clinical results. Clinical results were good considering the advanced stage of Kienböck's disease. Even with displaced fractures of the lunate, radial osteotomy yields results comparable with other treatments for same-stage patients and thus represents a reasonable approach.
晚期月骨缺血性坏死常伴有月骨移位骨折；然而，此类骨折是否会影响手术效果仍不清楚。本研究的目的是评估针对伴有月骨移位骨折的月骨缺血性坏死行桡骨截骨术的效果，以及这些骨折是否会实现愈合。
我们回顾了1975年至2004年间因月骨缺血性坏死而行桡骨截骨术的患者。我们仅纳入在侧位X线片上可见的月骨移位骨折，最终31例患者（24例男性，7例女性；平均年龄35岁）纳入本研究。对骨折愈合和未愈合病例的月骨术后状态及临床结果进行比较。
术前，平均屈伸弧为76度，平均握力为22千克。术后，平均屈伸弧为84度，平均握力为30千克。X线片显示16例腕关节骨折愈合。在任何评估的临床项目中，愈合组和未愈合组之间均未发现显著差异。
本研究表明桡骨截骨术后骨折愈合率约为50%。骨折愈合并不影响临床结果。考虑到月骨缺血性坏死的晚期阶段，临床结果良好。即使存在月骨移位骨折，桡骨截骨术的效果与同阶段患者的其他治疗方法相当，因此是一种合理的治疗方法。
