Department of Hand and Upper Extremity Surgery, Lapeyronie Teaching Hospital Center, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
Orthop Traumatol Surg Res. 2012 Jun;98(4):390-7. doi: 10.1016/j.otsr.2011.11.013. Epub 2012 May 16.
Avascular necrosis of the scaphoid (Preiser's disease) is a rare entity for which there are no treatment guidelines to date. The aim of this study was to delineate the optimal treatment at different stages of this disease, based on an analysis of the cases treated in our department.
Ten wrists (nine patients) were retrospectively reviewed after a mean 92 months of follow-up. The initial diagnosis was stage II avascular necrosis in four cases, stage III in four cases and stage IV in two cases. These patients were treated by conservative treatment (non surgical) in three cases, vascularized bone graft in two and palliative treatments (proximal row carpectomy or partial fusion) in five. Radiological examination, sometimes completed by MRI, and functional assessment of range of motion, grip strength and Mayo Wrist Score were performed.
Completely different results were obtained in the two stage II cases treated by conservative treatment, while functional results improved in the two cases treated by vascularized bone graft with regression of necrosis on MRI. Pain improved following palliative treatment in 4/5 stage III and IV wrists. Functional results were satisfactory with conservative treatment in one stage IV case for 13 years but worsened at the final follow-up assessment.
A review of the literature, including 126 cases in 29 articles clarified the role of conservative treatment, vascularized bone grafts and proximal row carpectomy in the treatment of avascular necrosis of the scaphoid. Conservative treatment is ineffective in the early stages and nearly always results in disease progression. In contrast vascularized bone grafts can stop or even reverse damage at stage II. Palliative treatment is indicated when facing irreversible lesions.
Level IV - Retrospective study.
舟状骨缺血性坏死（普雷瑟氏病）较为罕见，目前尚无治疗指南。本研究旨在根据我科治疗的病例分析，明确该病不同阶段的最佳治疗方法。
10 例 9 例患者）经平均 92 个月的随访后进行回顾性分析。初诊时 4 例为 II 期缺血性坏死，4 例为 III 期，2 例为 IV 期。这 3 例患者采用非手术保守治疗，2 例采用带血管骨移植，5 例采用姑息性治疗（近排腕骨切除术或部分融合术）。进行了影像学检查，有时还进行了 MRI 检查，以及对活动范围、握力和 Mayo 腕关节评分等功能评估。
2 例经保守治疗的 II 期患者结果完全不同，而 2 例经带血管骨移植治疗的患者，坏死在 MRI 上得到改善，功能得到改善。在 4/5 例 III 期和 IV 期腕关节中，姑息治疗后疼痛得到缓解。1 例 IV 期患者采用保守治疗 13 年，功能结果满意，但最终随访评估时恶化。
对文献的回顾，包括 29 篇文章中的 126 例，阐明了保守治疗、带血管骨移植和近排腕骨切除术在治疗舟状骨缺血性坏死中的作用。保守治疗在早期无效，几乎总是导致疾病进展。相比之下，带血管骨移植可在 II 期停止甚至逆转损伤。当面对不可逆转的病变时，姑息治疗是指征。
IV 级-回顾性研究。
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