Kawanishi Yohei, Moritomo Hisao, Omokawa Shohei, Murase Tsuyoshi, Sugamoto Kazuomi, Yoshikawa Hideki
Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan.
Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamada-oka, Suita; Department of Physical Therapy, Osaka Yukioka College of Health Science, Sojiji, Ibaraki-shi, Osaka; Department of Orthopedics, Nara Medical University, Kitayamato, Ikoma Nara, Japan.
J Hand Surg Am. 2015 Jan;40(1):74-80. doi: 10.1016/j.jhsa.2014.10.035.
To examine 3-dimensional carpal alignment and radioscaphoid joint (RSJ) congruity among normal wrists and those with Lichtman stage III Kienböck disease or scapholunate dislocation (SLD).
We conducted 3-dimensional analysis based on computed tomographic data to compare 10 wrists of stage III Kienböck disease (5 IIIa and 5 IIIb) with 5 normal wrists and 3 wrists with SLD. A markerless bone registration technique was used to investigate the 3-dimensional position of the scaphoid relative to the radius. To evaluate RSJ congruency, the inferred contact area between the scaphoid proximal pole and the distal radius was calculated from 3-dimensional bone models.
The scaphoid position was not significantly different from normal wrists in stage IIIa Kienböck disease. Stage IIIb Kienböck disease was meaningfully associated with a flexed scaphoid and proximal translation of the centroid, but not dorsal translation of the scaphoid proximal pole, where RSJ congruity was preserved. With SLD, the scaphoid flexed to the same extent as that in stage IIIb Kienböck disease, and the proximal pole translated dorsally together with the capitate, producing RSJ incongruity.
The patterns of carpal collapse differed between stage IIIb Kienböck disease and SLD in terms of RSJ congruity. Our study showed that stage IIIb Kienböck disease did not involve dorsal subluxation of the scaphoid proximal pole and that RSJ congruity was retained, unlike SLD.
Our results suggest that carpal collapse in Kienböck disease is not associated with RSJ incongruity, which may explain why there are asymptomatic patients with Kienböck disease and carpal collapse.
研究正常腕关节与 Lichtman Ⅲ期月骨无菌性坏死或舟月关节脱位（SLD）患者腕关节的三维排列及桡舟关节（RSJ）的一致性。
我们基于计算机断层扫描数据进行三维分析，以比较 10 例Ⅲ期月骨无菌性坏死腕关节（5 例Ⅲa 期和 5 例Ⅲb 期）、5 例正常腕关节和 3 例 SLD 腕关节。采用无标记骨配准技术研究舟骨相对于桡骨的三维位置。为评估 RSJ 的一致性，从三维骨模型计算舟骨近端极与桡骨远端之间的推断接触面积。
Ⅲa 期月骨无菌性坏死患者的舟骨位置与正常腕关节无显著差异。Ⅲb 期月骨无菌性坏死与舟骨屈曲及质心近端移位有显著相关性，但与舟骨近端极背侧移位无关，此时 RSJ 一致性得以保留。对于 SLD，舟骨屈曲程度与Ⅲb 期月骨无菌性坏死相同，且近端极与头状骨一起背侧移位，导致 RSJ 不一致。
Ⅲb 期月骨无菌性坏死和 SLD 在 RSJ 一致性方面的腕骨塌陷模式不同。我们的研究表明，Ⅲb 期月骨无菌性坏死不涉及舟骨近端极背侧半脱位，且 RSJ 一致性得以保留，这与 SLD 不同。
我们的结果表明，月骨无菌性坏死中的腕骨塌陷与 RSJ 不一致无关，这可能解释了为何存在无症状的月骨无菌性坏死和腕骨塌陷患者。
