Tomori Yuji, Sawaizumi Takuya, Mitsuhiko Nanno, Takai Shinro
Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan.
Medicine (Baltimore). 2017 Dec;96(48):e9002. doi: 10.1097/MD.0000000000009002.
Idiopathic avascular necrosis of the scaphoid or lunate bone are known as Preiser disease and Kienböck disease, respectively. Although there are reports of avascular necrosis involving more than one carpal bone, concurrent idiopathic avascular necrosis of the scaphoid and lunate bones is rare, with only five cases reported in the English literature (including the two herein). Although the optimum treatment for Preiser disease with concomitant Kienböck disease has not been established, our cases underwent closed radial wedge osteotomy based on the evidence of satisfactory outcomes for treating Kienböck disease. We report the medium-term results of closed radial wedge osteotomy of the distal radius in two cases of Preiser disease with concomitant Kienböck disease.
We presented two patients with concomitant Preiser and Kienböck diseases. Although both smoked cigarettes, neither had any other risk factors; there was no history of trauma, although both women had jobs that required relatively heavy or repetitive manual labor.
Two patients were diagnosed by radiographs and magnetic resonance imaging of the wrists.
A non-surgical strategy of splint immobilization and analgesia was not effective, and surgery was ultimately required.
Satisfactory medium-term results were achieved with closed radial wedge osteotomy of the distal radius in both cases. Although there was imaging evidence of progression of dorsal intercalated segmental instability deformity, neither of the patients was symptomatic and both declined salvage surgery.
We compare our cases and treatment strategy with others reported in the literature. Our cases suggest that closed radial wedge osteotomy of the distal radius is a safe and relatively straightforward means of treating patients with this rare combination of wrist disorders, and appears to obviate the need for more extensive salvage procedures.
舟骨或月骨的特发性缺血性坏死分别被称为普赖泽病和金伯克病。尽管有报道称缺血性坏死累及多块腕骨，但舟骨和月骨同时发生特发性缺血性坏死的情况罕见，英文文献中仅报道过5例（包括本文中的2例）。虽然普赖泽病合并金伯克病的最佳治疗方法尚未确定，但基于治疗金伯克病有满意疗效的证据，我们的病例采用了闭合性桡骨楔形截骨术。我们报告了2例普赖泽病合并金伯克病患者行桡骨远端闭合性楔形截骨术的中期结果。
我们介绍了2例同时患有普赖泽病和金伯克病的患者。尽管两人都吸烟，但均无其他危险因素；两人都没有外伤史，不过这两名女性的工作都需要相对繁重或重复性的体力劳动。
通过腕部X线片和磁共振成像对2例患者进行了诊断。
夹板固定和镇痛的非手术策略无效，最终需要手术治疗。
2例患者均通过桡骨远端闭合性楔形截骨术取得了满意的中期结果。尽管影像学证据显示背侧插入节段性不稳定畸形有进展，但两名患者均无症状，且都拒绝了挽救性手术。
我们将我们的病例和治疗策略与文献中报道的其他病例进行了比较。我们的病例表明，桡骨远端闭合性楔形截骨术是治疗这种罕见的腕部疾病组合患者的一种安全且相对简单的方法，而且似乎无需进行更广泛的挽救性手术。
