掌长肌腱切除关节成形术对3期月骨无菌性坏死患者腕骨高度比的影响。

Küçük Levent, Ozdemir Oğuz, Coşkunol Erhan, Süğün Tahir S, Ozaksar Kemal

Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, İzmir, Turkey.

Acta Orthop Traumatol Turc. 2011;45(6):393-8. doi: 10.3944/AOTT.2011.2566.

OBJECTIVE

Treatment methods in Kienböck's disease remain controversial despite the long-term awareness of the disease by orthopedic surgeons. Currently, excisional arthroplasty with a palmaris longus tendon ball is one of the most frequently used treatment methods. The aim of this study was to evaluate the long-term results of thirty-eight patients who had been treated with excisional arthroplasty and palmaris longus tendon ball, as well as the effect of this method on carpal height.

METHODS

In this study, we retrospectively evaluated 38 patients (mean age: 30.4 years; range: 17-64 years) with Stage 3 Kienböck's disease who underwent excisional arthroplasty between 1978 and 2008. According to the Lichtman classification, 8 patients were classified as Stage 3a and 30 patients were classified as Stage 3b in Kienböck's disease. The mean duration of follow-up after surgery was 81.3 (range: 25 to 264) months. The outcomes were evaluated with joint range of motion, grip strength and functional assessment of Nakamura and radiographic changes in carpal height.

RESULTS

According to the Nakamura's scoring system the results were excellent in 22 (57.9%) patients, good in 13 (34.2%) and moderate in 3 (7.9%). Comparison of pre and postoperative range of motion of the wrist revealed an average increase in wrist extension of 10° (p<0.05), and an average decrease in ulnar deviation of 4° (p<0.05) after the operation. No significant difference was observed when comparing other joint range of motion parameters. Dynamometric grip strength measurements revealed significant differences between the healthy and operated sides (67.6 kgf vs. 45.9 kgf, respectively; p<0.05). The decrease in the revised carpal height ratio were significant.

CONCLUSION

According to patient satisfaction rate and clinical results, the outcome of excisional arthroplasty with palmaris longus tendon ball in Stage 3 Kienböck's disease is satisfactory. However, carpal height reduction and development of degenerative changes may be expected in long-term follow-up.

目的

尽管骨科医生对月骨无菌性坏死病已有长期认识，但该病的治疗方法仍存在争议。目前，掌长肌腱球切除关节成形术是最常用的治疗方法之一。本研究的目的是评估38例行掌长肌腱球切除关节成形术患者的长期疗效，以及该方法对腕骨高度的影响。

方法

本研究回顾性评估了1978年至2008年间接受切除关节成形术的38例3期月骨无菌性坏死病患者（平均年龄：30.4岁；范围：17 - 64岁）。根据Lichtman分类，月骨无菌性坏死病中8例为3a期，30例为3b期。术后平均随访时间为81.3（范围：25至264）个月。通过关节活动范围、握力以及中村功能评估和腕骨高度的影像学变化来评估疗效。

结果

根据中村评分系统，22例（57.9%）患者结果为优，13例（34.2%）为良，3例（7.9%）为中。术前和术后腕关节活动范围比较显示，术后腕关节背伸平均增加10°（p<0.05），尺偏平均减少4°（p<0.05）。比较其他关节活动范围参数时未观察到显著差异。握力测量显示健侧与手术侧之间存在显著差异（分别为67.6 kgf和45.9 kgf；p<0.05）。改良腕骨高度比降低显著。