Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University of Tübingen, Schnarrenbergstr. 95, 72076 Tübingen, Germany.
Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University of Tübingen, Schnarrenbergstr. 95, 72076 Tübingen, Germany.
J Plast Reconstr Aesthet Surg. 2014 Oct;67(10):1415-26. doi: 10.1016/j.bjps.2014.05.037. Epub 2014 Jun 2.
Scientific databases index numerous references related to the treatment of Kienböck's disease; yet little is known about the nature of the disease and its pathognomonic features. This study provides a cross-sectional analysis of the pattern and extent of osteonecrosis in a large cohort and a longitudinal analysis to determine the spontaneous disease progression in single patients who have not had surgical management until fragmentation of the lunate.
In a prospective case series, the pattern and extent of osteonecrosis were correlated with the duration of symptoms in all patients with Kienböck's disease confirmed using high-resolution 3-T magnetic resonance imaging (MRI) and ultra-thin section computed tomographic (CT) scan since 2009. Furthermore, a retrospective consecutive case series study was conducted to determine the rate of spontaneous evolution in all consecutive patients treated conservatively in our university hospital since 1990.
Among the 35 consecutive patients with Kienböck's disease diagnosed in high-resolution 3-T MRI and ultra-thin section CT, 46% (16/35) presented degeneration of lunate cartilage on CT scan in the first 12 months following the onset of symptoms. Median wrist pain duration of patients presenting a fracture of the lunate was 14 months. Thirty-one percent (11/35) of the patients had arthritis of the lunate, yet no fractures at the time of examination. Of 106 consecutive patients with Kienböck's disease and complete records, who did not have surgical intervention until fragmentation of the lunate, three cases were identified with well-documented spontaneous courses from apparently intact lunate morphology until fragmentation within 6 months.
Kienböck's disease progresses substantially faster than previously described and, contrary to current classifications, the articular cartilage of the lunate degenerates in early stages.
Diagnostic accuracy, Level IV.
科学数据库索引了大量与治疗 Kienböck 病相关的参考文献；然而，人们对该病的性质及其特征性表现知之甚少。本研究通过大样本的横断面分析和对未经手术治疗直至月骨碎裂的单例患者的纵向分析，提供了 Kienböck 病患者的骨坏死模式和范围。
在一项前瞻性病例系列研究中，通过高分辨率 3-T 磁共振成像（MRI）和超薄层 CT 扫描，对 2009 年以来确诊的所有 Kienböck 病患者的骨坏死模式和范围与症状持续时间进行相关性分析。此外，对 1990 年以来在我院接受保守治疗的所有连续病例进行回顾性连续病例系列研究，以确定所有连续患者自发性演变的发生率。
在高分辨率 3-T MRI 和超薄层 CT 诊断的 35 例连续 Kienböck 病患者中，46%（16/35）在症状出现后 12 个月内的 CT 扫描上出现月骨软骨退变。出现月骨骨折患者的腕部疼痛中位持续时间为 14 个月。31%（11/35）的患者有月骨关节炎，但在检查时无骨折。在有完整记录的 106 例连续 Kienböck 病患者中，在未进行手术干预直至月骨碎裂的情况下，有 3 例患者的月骨形态明显完整，直至 6 个月内出现碎裂，其自发病程有明确记录。
Kienböck 病的进展速度明显快于之前的描述，与当前的分类相反，月骨的关节软骨在早期就会退化。
诊断准确性，IV 级。
