Matsui Yuichiro, Funakoshi Tadanao, Motomiya Makoto, Urita Atsushi, Minami Michio, Iwasaki Norimasa
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan; Department of Orthopaedic Surgery, Kushiro Rosai Hospital, Kushiro, Japan.
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan; Department of Orthopaedic Surgery, Kushiro Rosai Hospital, Kushiro, Japan.
J Hand Surg Am. 2014 Apr;39(4):679-85. doi: 10.1016/j.jhsa.2014.01.020. Epub 2014 Mar 5.
To clarify long-term clinical and radiological results more than 10 years after radial shortening osteotomy for Kienböck disease.
Eleven wrists of 10 patients that had been classified as Lichtman stages 3A (2 wrists), 3B (8 wrists), and 4 (1 wrist) underwent radial shortening for Kienböck disease. The mean follow-up period was 14.3 years (range, 10-21 y). Clinical outcomes were quantified using the Japanese version of the Disabilities of the Arm, Shoulder, and Hand questionnaire and the modified Mayo wrist score. Radiographic and magnetic resonance imaging studies were performed for 9 of the 10 patients preoperatively and all 10 patients at follow-up.
At follow-up, 6 wrists were asymptomatic and the remaining 5 had mild occasional pain. The mean range of extension and grip strength significantly improved. The mean modified Mayo wrist score and Disabilities of the Arm, Shoulder, and Hand scores were 92 (range, 80-100) and 5 (range, 0-18), respectively. At follow-up, no progression of the Lichtman stage was found in any patient. There was no significant progressive lunate collapse in any patient. The magnetic resonance imaging in 7 wrists showed increased signal intensity of the lunate; the remaining 3 wrists had no alteration in signal intensity of the bone.
Our study demonstrated satisfactory clinical results after 10 or more years in patients who underwent radial shortening for Kienböck disease. Although we found no improvement in signal intensity of the lunate in 3 wrists, unloading of the diseased lunate after radial shortening gives long-lasting symptom relief and may prevent lunate collapse.
TYPE OF STUDY/LEVEL OF DISEASE: Therapeutic IV.
阐明针对月骨无菌性坏死进行桡骨缩短截骨术后10年以上的长期临床和影像学结果。
10例患者的11个腕关节，被分类为Lichtman 3A期（2个腕关节）、3B期（8个腕关节）和4期（1个腕关节），因月骨无菌性坏死接受了桡骨缩短手术。平均随访期为14.3年（范围10 - 21年）。使用日本版上肢、肩部和手部功能障碍问卷以及改良的梅奥腕关节评分对临床结果进行量化。对10例患者中的9例在术前进行了影像学和磁共振成像研究，对所有10例患者在随访时进行了相关检查。
随访时，6个腕关节无症状，其余5个有轻度偶尔疼痛。平均伸展范围和握力显著改善。平均改良梅奥腕关节评分和上肢、肩部和手部功能障碍评分分别为92分（范围80 - 100）和5分（范围0 - 18）。随访时，未发现任何患者的Lichtman分期有进展。任何患者均未出现明显的进行性月骨塌陷。7个腕关节的磁共振成像显示月骨信号强度增加；其余3个腕关节的骨信号强度无改变。
我们的研究表明，因月骨无菌性坏死接受桡骨缩短手术的患者在10年或更长时间后临床结果令人满意。尽管我们发现3个腕关节的月骨信号强度没有改善，但桡骨缩短后病变月骨的负荷减轻可带来持久的症状缓解，并可能预防月骨塌陷。
研究类型/疾病分级：治疗性IV级。
