Department for Plastic Surgery, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University of Tübingen, Tübingen, Germany.
BMC Musculoskelet Disord. 2012 Nov 21;13:225. doi: 10.1186/1471-2474-13-225.
We systematically reviewed etiological factors of Kienböck's disease (osteonecrosis of the lunate) discussed in the literature in order to examine the justification for including Kienböck's disease (KD) in the European Listing of Occupational Diseases.
We searched the Ovid/Medline and the Cochrane Library for articles discussing the etiology of osteonecrosis of the lunate published since the first description of KD in 1910 and up until July 2012 in English, French or German. Literature was classified by the level of evidence presented, the etiopathological hypothesis discussed, and the author's conclusion about the role of the etiopathological hypothesis. The causal relationship between KD and hand-arm vibration was elucidated by the Bradford Hill criteria.
A total of 220 references was found. Of the included 152 articles, 140 (92%) reached the evidence level IV (case series). The four most frequently discussed factors were negative ulnar variance (n=72; 47%), primary arterial ischemia of the lunate (n=63; 41%), trauma (n=63; 41%) and hand-arm vibration (n=53; 35%). The quality of the cohort studies on hand-arm vibration did not permit a meta-analysis to evaluate the strength of an association to KD. Evidence for the lack of consistency, plausibility and coherence of the 4 most frequently discussed etiopathologies was found. No evidence was found to support any of the nine Bradford Hill criteria for a causal relationship between KD and hand-arm vibration.
A systematic review of 220 articles on the etiopathology of KD and the application of the Bradford Hill criteria does not provide sufficient scientific evidence to confirm or refute a causal relationship between KD and hand-arm vibration. This currently suggests that, KD does not comply with the criteria of the International Labour Organization determining occupational diseases. However, research with a higher level of evidence is required to further determine if hand-arm vibration is a risk factor for KD.
我们系统地回顾了文献中关于 Kienböck 病（月骨缺血性坏死）病因的研究，以检验将 Kienböck 病（KD）列入欧洲职业病清单的合理性。
我们在 Ovid/Medline 和 Cochrane 图书馆中检索了自 1910 年首次描述 KD 以来至 2012 年 7 月发表的讨论月骨缺血性坏死病因的英文、法文或德文文献。文献按照提出的证据水平、讨论的病因假说以及作者对病因假说作用的结论进行分类。KD 与手部-手臂振动之间的因果关系通过 Bradford Hill 标准来阐明。
共发现 220 篇参考文献。纳入的 152 篇文章中，140 篇（92%）达到证据水平 IV（病例系列）。讨论最多的四个因素是负性尺骨变异（n=72；47%）、月骨原发性动脉缺血（n=63；41%）、创伤（n=63；41%）和手部-手臂振动（n=53；35%）。手部-手臂振动的队列研究质量不允许进行荟萃分析来评估与 KD 的关联强度。发现缺乏一致性、合理性和可理解性的证据，以支持最常讨论的 4 种病因病理学。没有证据支持 KD 与手部-手臂振动之间因果关系的九个 Bradford Hill 标准中的任何一个。
对 KD 病因学的 220 篇文章进行系统回顾，并应用 Bradford Hill 标准，没有提供足够的科学证据来证实或反驳 KD 与手部-手臂振动之间的因果关系。这表明 KD 目前不符合国际劳工组织确定职业病的标准。然而，需要进行更高水平的证据研究来进一步确定手部-手臂振动是否是 KD 的一个危险因素。
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