Fujiwara Hiroyoshi, Oda Ryo, Morisaki Shinsuke, Ikoma Kazuya, Kubo Toshikazu
Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Hand Surg Am. 2013 May;38(5):904-8. doi: 10.1016/j.jhsa.2013.02.010. Epub 2013 Apr 3.
Vascularized bone grafting (VBG) is one of the therapeutic approaches for treating advanced Kienböck disease; however, few reports on long-term outcomes are available for this technique. The purpose of this study is to evaluate long-term results by following up patients with stage III Kienböck disease for more than 10 years after VBG.
The study included 18 patients with advanced Kienböck disease (Lichtman stage IIIA, n = 10; stage IIIB, n = 8) who received VBG between 1996 and 2001 and were followed up for at least 10 years. Eleven patients received transplantation from the metacarpal base and 7 patients from the distal radius. Radial shortening and capitate shortening were performed in 5 and 2 stage IIIB patients, respectively.
The mean follow-up period was 12 years, 3 months. Based on the Mayo Modified Wrist Score, clinical results were excellent in 8 patients, good in 7 patients, and fair in 3 patients. The Stahl index and carpal height ratio were not improved in stage IIIA patients who received bone graft alone, whereas significant improvement was observed in stage IIIB patients who received shortening, as well.
Vascularized bone grafting for stage III Kienböck disease demonstrated favorable long-term results and is recommended as a surgical treatment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
带血管蒂骨移植（VBG）是治疗晚期月骨无菌性坏死的方法之一；然而，关于该技术长期疗效的报道较少。本研究的目的是通过对III期月骨无菌性坏死患者进行带血管蒂骨移植术后10年以上的随访，评估其长期疗效。
本研究纳入了18例晚期月骨无菌性坏死患者（Lichtman IIIA期，10例；IIIB期，8例），这些患者在1996年至2001年间接受了带血管蒂骨移植，并至少随访了10年。11例患者接受了来自掌骨基底的移植，7例患者接受了来自桡骨远端的移植。分别对5例IIIB期患者进行了桡骨缩短术，对2例IIIB期患者进行了头状骨缩短术。
平均随访时间为12年3个月。根据Mayo改良腕关节评分，8例患者临床结果为优，7例为良，3例为中。单纯接受骨移植的IIIA期患者的Stahl指数和腕骨高度比未得到改善，而接受缩短术的IIIB期患者也观察到了显著改善。
III期月骨无菌性坏死的带血管蒂骨移植显示出良好的长期疗效，推荐作为一种手术治疗方法。
研究类型/证据水平：治疗性III级。
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