Rhee Peter C, Jones David B, Moran Steven L, Shin Alexander Y
Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, TX; Orthopedic Institute, Sioux Falls, SD; Division of Hand Surgery, Mayo Clinic, Rochester, MN; Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Division of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, TX; Orthopedic Institute, Sioux Falls, SD; Division of Hand Surgery, Mayo Clinic, Rochester, MN; Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Division of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Hand Surg Am. 2015 Apr;40(4):738-44. doi: 10.1016/j.jhsa.2014.12.024. Epub 2015 Feb 18.
To determine if the absence (type I lunate) or presence (type II lunate) of a medial hamate facet on the lunate affects the radiographic characteristics of patients presenting with Kienböck disease.
A retrospective review was performed on all patients evaluated at our institution from 2002 to 2010 with a diagnosis of Kienböck disease confirmed on plain radiographs in concert with magnetic resonance imaging (MRI) and/or bone scan. Study groups consisted of patients with type I versus type II lunates, as determined by radiographs, MRI, and/or computed tomography. Measured variables included the modified Lichtman stage on presentation, radioscaphoid angle, presence or absence of a coronal plane fracture of the lunate, modified carpal height, ulnar variance, and ulnar translocation of the carpus at the time of presentation.
A total of 106 wrists were examined, of which 75 were type I (71%) and 31 were type II (29%) lunates. At the time of presentation, there was significantly more advanced disease (stage IIIA or greater) in patients with type I (N = 64, 86%) compared with those with type II lunates (N = 19, 61%). Coronal fractures of the lunate were more prevalent in patients with type I (N = 58, 75%) compared with type II lunates (N = 18, 58%). In the absence of a coronal fracture, radioscaphoid angles were greater in patients with a type I (53°) versus a type II lunate (45°).
Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation. Type II lunates appear to be protective against coronal fractures and scaphoid flexion deformities. This study provides further evidence that lunate morphology affects carpal pathology and may have implications for treatment options in Kienböck disease.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
确定月骨内侧钩骨小关节缺如（I型月骨）或存在（II型月骨）是否会影响患有Kienböck病患者的影像学特征。
对2002年至2010年在本机构接受评估的所有患者进行回顾性研究，这些患者经X线平片确诊为Kienböck病，并结合磁共振成像（MRI）和/或骨扫描。研究组由根据X线片、MRI和/或计算机断层扫描确定为I型与II型月骨的患者组成。测量变量包括就诊时的改良Lichtman分期、桡舟角、月骨冠状面骨折的有无、改良腕骨高度、尺骨变异以及就诊时腕骨的尺骨移位。
共检查了106例腕关节，其中75例为I型月骨（71%），31例为II型月骨（29%）。就诊时，I型月骨患者（N = 64，86%）的疾病进展明显比II型月骨患者（N = 19，61%）更严重（IIIA期或更高级别）。I型月骨患者（N = 58，75%）的月骨冠状面骨折比II型月骨患者（N = 18，58%）更常见。在没有冠状面骨折的情况下，I型月骨患者的桡舟角（53°）大于II型月骨患者（45°）。
月骨形态可能会影响Kienböck病初次就诊时的严重程度。II型月骨似乎可预防冠状面骨折和舟骨屈曲畸形。本研究进一步证明月骨形态会影响腕骨病理，并可能对Kienböck病的治疗选择产生影响。
研究类型/证据水平：预后性研究III级。
