Buck-Gramcko D, Lankers J
Abteilung für Handchirurgie und Plastische Chirurgie, Berufsgenossenschaftliches Unfallkrankenhaus, Hamburg.
Handchir Mikrochir Plast Chir. 1990 Jan;22(1):28-38.
The results of nine different methods for treating patients with lunate necrosis were investigated in a retrospective study. The study included seventy-eight of eighty-two operated patients with an average follow-up of five years and thirteen of thirty-five patients conservatively treated were examined at an average follow-up time of nine years. Treatments used were: shortening of the radius, lengthening of the ulna, pisiform transposition, prosthetic replacement, tendon interposition arthroplasty, STT-arthrodesis (scaphotrapezio-trapezoid arthrodesis), denervation of the wrist, wrist arthrodesis, and conservative therapy. The most important criteria for rating the results were pain relief, range of motion, grip strength, and X-ray findings. In the early stages of lunate necrosis with a minus variant of the ulna the best results were obtained by shortening of the radius. In intermediate stages good results could be achieved by tendon interposition arthroplasty. Denervation and STT-arthrodesis can be performed at any stage of the disease and may be combined with other methods. Despite some good results, a search for even better operative methods should continue, because the available techniques, especially in cases of advanced necrosis, do not always lead to satisfactory results.
在一项回顾性研究中，对九种不同治疗月骨坏死患者的方法的结果进行了调查。该研究纳入了八十二例手术患者中的七十八例，平均随访五年；三十五例保守治疗患者中的十三例，平均随访时间为九年。所采用的治疗方法包括：桡骨缩短、尺骨延长、豌豆骨移位、假体置换、肌腱植入关节成形术、STT关节融合术（舟状骨-大多角骨-小多角骨关节融合术）、腕部去神经支配、腕关节融合术以及保守治疗。评估结果的最重要标准是疼痛缓解、活动范围、握力和X线表现。在伴有尺骨负变异的月骨坏死早期，桡骨缩短可取得最佳效果。在中期，肌腱植入关节成形术可取得良好效果。去神经支配和STT关节融合术可在疾病的任何阶段进行，并且可与其他方法联合使用。尽管取得了一些良好结果，但仍应继续寻找更好的手术方法，因为现有的技术，尤其是在晚期坏死病例中，并不总是能带来令人满意的结果。
