Shimizu Takamasa, Omokawa Shohei, del Piñal Francisco, Shigematsu Koji, Moritomo Hisao, Tanaka Yasuhito
Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
Department of Orthopedic Surgery, Nara Medical University, Nara, Japan; Department of Hand Surgery, Nara Medical University, Nara, Japan.
J Hand Surg Am. 2015 Dec;40(12):2393-400. doi: 10.1016/j.jhsa.2015.09.010.
To examine short-term clinical results of arthroscopic partial resection for type Ia avascular necrosis of the capitate.
Patients who underwent arthroscopic treatment for type 1a avascular necrosis of the capitate with at least 1-year follow-up were identified through a retrospective chart review. The necrotic capitate head was arthroscopically resected with removal of the lunate facet and preservation of the scaphoid and hamate facets. Wrist range of motion, grip strength, and radiographic parameters--carpal height ratio, radioscaphoid angle, and radiolunate angle-were determined before surgery and at the latest follow-up. Patients completed a visual analog scale for pain; Disabilities of the Arm, Shoulder, and Hand measure; and the Patient-Rated Wrist Evaluation score before surgery and at the latest follow-up.
Five patients (1 male, 4 females) with a mean age of 34 years (range, 16-49 years) and a mean follow-up duration of 20 months (range, 12-36 months) were identified during the chart review. All were type Ia (Milliez classification). Arthroscopy revealed fibrillation or softening with cartilage detachment at the lunate facet of the capitate head and an intact articular surface at the scaphoid and hamate facet. At the latest follow-up, the mean wrist flexion-extension was 123° (vs 81° before surgery) and grip strength was 74% (vs 37% before surgery). The visual analog scale score for pain; the Disabilities of the Arm, Shoulder, and Hand score; and the Patient-Rated Wrist Evaluation score before surgery showed a significant improvement following treatment. Radiographic parameters did not significantly change at the final follow-up, although the proximal carpal row trended toward flexion.
Arthroscopic partial resection of the capitate head was an acceptable treatment for type Ia avascular necrosis of the capitate. It provided adequate pain relief and improved the range of wrist motion and grip strength during short-term follow-up.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
探讨关节镜下部分切除治疗头状骨Ia型缺血性坏死的短期临床效果。
通过回顾性病历审查，确定接受关节镜治疗头状骨Ia型缺血性坏死且随访至少1年的患者。在关节镜下切除坏死的头状骨头，去除月骨小面，保留舟骨和钩骨小面。在手术前和最新随访时测定腕关节活动范围、握力以及影像学参数——腕骨高度比、桡舟角和桡月角。患者在手术前和最新随访时完成疼痛视觉模拟量表、手臂、肩部和手部功能障碍评估以及患者自评腕关节评估评分。
在病历审查中确定了5例患者（1例男性，4例女性），平均年龄34岁（范围16 - 49岁），平均随访时间20个月（范围12 - 36个月）。所有患者均为Ia型（米列兹分类）。关节镜检查显示头状骨头月骨小面有纤维颤动或软化伴软骨脱落，舟骨和钩骨小面关节面完整。在最新随访时，平均腕关节屈伸角度为123°（术前为81°），握力为74%（术前为37%）。治疗后，疼痛视觉模拟量表评分、手臂、肩部和手部功能障碍评分以及患者自评腕关节评估评分术前与术后相比有显著改善。尽管近端腕骨排有屈曲趋势，但在最后随访时影像学参数无显著变化。
关节镜下头状骨头部分切除是治疗头状骨Ia型缺血性坏死的一种可接受的治疗方法。在短期随访中，它提供了足够的疼痛缓解，并改善了腕关节活动范围和握力。
研究类型/证据水平：治疗性IV级。
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