Hegazy Galal, Akar Ahmed, Abd-Elghany Tharwat, Zayed Emad, Shaheen Elsayed, Mansour Tarek
Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt.
Orthopedic Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt.
J Hand Surg Am. 2019 Jun;44(6):518.e1-518.e9. doi: 10.1016/j.jhsa.2018.08.010. Epub 2018 Oct 8.
We evaluated whether a surgical technique combining distal capitate shortening and arthrodesis to the base of the third metacarpal bone for the treatment of the early stages (stages II and IIIA) of Kienböck's disease with neutral ulnar variance resulted in pain relief, improvement in wrist motion, or changes in the radiographic evaluation.
This retrospective study reviewed 22 patients with early stages of Kienböck's disease with neutral ulnar variance, treated by distal capitate shortening and arthrodesis to the base of the third metacarpal bone. Patients were divided into 2 groups by disease stage: stage II (n = 12) and stage IIIA (n = 10). There were 8 women and 14 men, with an average age of 35.7 years. The following parameters were measured before and after surgery: visual analog scale (VAS) for pain evaluation, grip strength, range of motion (ROM), ulnar variance, carpal height index, lunate height index, and the scapholunate and scaphocapitate angles. The patients were evaluated in accordance with Modified Mayo Wrist Score (MMWS).
The average follow-up period was 30.5 months (range, 26-36 months). The stage II group showed significant improvements in the mean VAS (58-5), ROM (57% to 73%), grip strength (54% to 75%), and MMWS (51-78). Patients in the stage IIIA group showed nonsignificant changes in mean VAS score (64-42.5), ROM (52.5% to 55.5%), grip strength (46.5% to 57.5%), and MMWS (36-50.5). Significant decreases in the carpal height index and scaphocapitate angle, and an increase in scapholunate angle in all stage IIIA patients were observed.
Distal capitate shortening with capitometacarpal arthrodesis can alleviate pain and improve ROM and grip strength in patients with stage II Kienböck's disease, but not in those with stage IIIA. Moreover, it cannot prevent carpal collapse, especially in stage IIIA of the disease. We do not recommend this technique for treating stage IIIA patients.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
我们评估了一种将头状骨远端缩短与第三掌骨基底关节融合相结合的手术技术，用于治疗中性尺骨变异的早期（II期和IIIA期）月骨无菌性坏死，是否能缓解疼痛、改善腕关节活动度或改变影像学评估结果。
这项回顾性研究纳入了22例中性尺骨变异的早期月骨无菌性坏死患者，采用头状骨远端缩短与第三掌骨基底关节融合术进行治疗。患者按疾病分期分为2组：II期（n = 12）和IIIA期（n = 10）。其中女性8例，男性14例，平均年龄35.7岁。在手术前后测量以下参数：用于疼痛评估的视觉模拟量表（VAS）、握力、活动范围（ROM）、尺骨变异、腕骨高度指数、月骨高度指数以及舟月角和舟头角。根据改良梅奥腕关节评分（MMWS）对患者进行评估。
平均随访期为30.5个月（范围26 - 36个月）。II期组在平均VAS（5.8 - 5）、ROM（57%至73%）、握力（54%至75%）和MMWS（51 - 78）方面有显著改善。IIIA期组患者的平均VAS评分（6.4 - 4.25）、ROM（52.5%至55.5%）、握力（46.5%至57.5%）和MMWS（36 - 50.5）无显著变化。观察到所有IIIA期患者的腕骨高度指数和舟头角显著降低，舟月角增加。
头状骨远端缩短与头掌关节融合术可缓解II期月骨无菌性坏死患者的疼痛，改善ROM和握力，但对IIIA期患者无效。此外，它无法预防腕骨塌陷，尤其是在疾病的IIIA期。我们不推荐该技术用于治疗IIIA期患者。
研究类型/证据水平：治疗性IV级。
