Huard S, Rochet S, Lepage D, Garbuio P, Obert L
Service de chirurgie orthopédique et traumatologique, CHU Jean-Minjoz, Besançon, France.
Chir Main. 2011 Jun;30(3):211-7. doi: 10.1016/j.main.2011.04.005. Epub 2011 May 7.
Treatment of advanced Kienböck's disease (Lichtmann IV) is commonly proximal row carpectomy or partial arthrodesis. The purpose of this study is to evaluate a more conservative treatment of advanced Kienböck's disease for young people: replacement of the lunate with a costochondral autograft. Between 2007 and 2009, four patients of mean age 40 years (32-51) were operated by two surgeons using this technique. This is a prospective study with a final follow-up by an independent operator. Mean follow-up was 27 months (6-36). Surgery is in two stages: excision of lunate and replacement with costochondral autograft taken from the ninth rib. Patients were evaluated with DASH and Cooney scores, pain, satisfaction, mobility and strength. Results show disappearance of pain at rest and during daily activities for all patients and a mean DASH of 6. Flexion-extension was 108° and grip strength 83% compared with the opposite side. Radiological evaluation showed no disease evolution. No complication was noted. Functional improvement was significant with good results compared to conventional techniques. Alternative techniques have been proposed for the replacement of the lunate, each with its specific problems. Lunate replacement by a costochondral graft is possible because studies showed vitality of this free graft up to five years. It also allows subsequent surgery. The absence of carpal collapse and good functional results are encouraging but the follow up is short. A long-term study is needed to confirm findings.
晚期月骨无菌性坏死（ Lichtmann IV期）的治疗通常采用近排腕骨切除术或部分关节融合术。本研究的目的是评估一种针对年轻人晚期月骨无菌性坏死的更保守治疗方法：用自体肋软骨移植替代月骨。2007年至2009年间，两名外科医生采用该技术为4例平均年龄40岁（32 - 51岁）的患者实施了手术。这是一项前瞻性研究，由一名独立操作人员进行最终随访。平均随访时间为27个月（6 - 36个月）。手术分两个阶段进行：切除月骨并用取自第九肋的自体肋软骨进行替代。采用DASH和Cooney评分、疼痛程度、满意度、活动度和力量对患者进行评估。结果显示，所有患者静息和日常活动时疼痛均消失，DASH平均评分为6分。与对侧相比，屈伸活动度为108°，握力为83%。影像学评估显示病情无进展。未观察到并发症。与传统技术相比，功能改善显著，效果良好。已提出了替代月骨的其他技术，每种技术都有其特定问题。用肋软骨移植替代月骨是可行的，因为研究表明这种游离移植体的活力可持续长达五年。它还允许后续手术。腕骨无塌陷且功能效果良好令人鼓舞，但随访时间较短。需要进行长期研究以证实研究结果。
