Arora R, Lutz M, Zimmermann R, Struve P, Pechlaner S, Gabl M
Universitätsklinik für Unfallchirurgie und Sporttraumatologie.
Handchir Mikrochir Plast Chir. 2010 Jun;42(3):198-203. doi: 10.1055/s-0030-1249614. Epub 2010 Apr 7.
The aim of this retrospective study is to report the clinical and radiological long-term results (follow-up >10 years) after revascularisation of the lunate in Kienböck's disease using a free vascularised iliac bone graft in patients with Lichtman stage III disease.
23 patients (14 male, 9 female) aged between 17 and 43 years were treated with a free vascularised iliac bone graft. The average follow-up time was 13 (10-15) years. Assessment included active range of wrist motion, grip strength, level of pain, patient disability and functional outcome measured by the DASH questionnaire as well as the Green and O'Brien score. Radiological evaluation included Ståhl index, Youm carpal height index, radioscaphoidal angle, radiolunate angle and integration of the free vascularised bone graft. All long-term results were compared to the preoperative state.
In 20 of 23 patients definite osteointegration of the vascularised bone graft was achieved. The average extension-flexion arc increased from 75 degrees to 100 degrees postoperatively and the average ulnar-radial deviation arc increased from 35 degrees to 45 degrees . The grip strength improved from 45 kg to 65 kg postoperatively and the pain level decreased from 65 to 6. Radiologically the average Ståhl index improved to 0.44 (preoperative 0.33), the average Youm index to 0.54 (preoperative 0.51) and the average radioscaphoidal angle to 50 degrees (preoperative 46 degrees ). The mean DASH score was 14.2. The Green and O'Brien score showed 11 (48%) excellent, 5 (22%) good, 4 (17%) fair und 3 (13%) bad results. 3 patients presented with a resorption of the bone graft with ongoing radiological progression of Lichtman stage, reduced range of motion and high pain level.
Free vascularised iliac bone grafts for Kienböck's disease is a reasonable treatment option and the clinical and radiological improvements last for a long period of time. Long-term restoration of carpal height was demonstrated. Progression of disease was prevented in 87% (20 of 23) of patients over a mean time of 13 years. In our hands this technique remains the best option for the treatment of Kienböck's disease stage III.
本回顾性研究旨在报告采用游离带血管蒂髂骨移植治疗 Lichtman III 期月骨无菌性坏死患者的临床及影像学长期结果（随访时间>10 年）。
23 例患者（男 14 例，女 9 例），年龄 17 - 43 岁，接受游离带血管蒂髂骨移植治疗。平均随访时间为 13（10 - 15）年。评估内容包括腕关节活动度、握力、疼痛程度、患者残疾情况以及通过 DASH 问卷测量的功能结果，还有 Green 和 O'Brien 评分。影像学评估包括 Ståhl 指数、Youm 腕骨高度指数、桡舟角、桡月角以及游离带血管蒂骨移植的融合情况。所有长期结果均与术前状态进行比较。
23 例患者中有 20 例实现了带血管蒂骨移植的明确骨融合。术后平均屈伸弧度从 75 度增加到 100 度，平均尺桡偏斜弧度从 35 度增加到 45 度。术后握力从 45 千克提高到 65 千克，疼痛程度从 65 降至 6。影像学上，平均 Ståhl 指数提高到 0.44（术前为 0.33），平均 Youm 指数提高到 0.54（术前为 0.51），平均桡舟角提高到 50 度（术前为 46 度）。平均 DASH 评分为 14.2。Green 和 O'Brien 评分显示，11 例（48%）为优，5 例（22%）为良，4 例（17%）为可，3 例（13%）为差。3 例患者出现骨移植吸收，Lichtman 分期有持续的影像学进展，关节活动度降低且疼痛程度高。
游离带血管蒂髂骨移植治疗月骨无菌性坏死是一种合理的治疗选择，临床和影像学改善可持续较长时间。腕骨高度得到长期恢复。在平均 13 年的时间里，87%（23 例中的 20 例）患者的疾病进展得到预防。在我们手中，这项技术仍然是治疗月骨无菌性坏死 III 期的最佳选择。
