Amariz Guilherme Augusto Silva, Abreu Maria Virginia Arranz, Veronesi Bruno Azevedo, de Rezende Marcelo Rosa
Grupo de Mão e Microcirurgia, Instituto de Ortopedia e Traumatología, Hospital das Clinicas (HC-FMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Acta Ortop Bras. 2018;26(5):286-289. doi: 10.1590/1413-785220182605208269.
Treatment of Kienböck's disease is challenging and the variability of results, despite the surgical technique, shows that there must be other aspects that can influence outcomes. The objective of this study is determine, through arthroscopic approach, the pattern of impairment of the carpal bones in Lichtman stage III patients.
Wrist arthroscopy was performed in patients with symptoms and evidence of lunate necrosis on x-rays, with signs of 3A and 3B stages. The Outerbridge classification was used to grade the articular status of the carpal bones.
Fifteen patients with stage 3 disease were assessed, five of whom were staged as type 3A and ten as 3B using the Lichtman stages. According to the Outerbridge classification, the lunate sulcus was the most affected with means of 2.8 at 3A and 2.9 at 3B. Other areas were significantly less affected with means of 1.1 and 1.3, respectively.
Arthroscopic assessment of the wrist could aid in surgical decision making, offering more details on cartilage status in stage 3 Kienböck's disease.
月骨无菌性坏死的治疗具有挑战性，尽管手术技术多样，但结果的差异性表明，一定存在其他影响治疗效果的因素。本研究的目的是通过关节镜检查确定 Lichtman III 期患者腕骨的损伤模式。
对有症状且 X 光显示有月骨坏死证据、呈现 3A 和 3B 期体征的患者进行腕关节镜检查。采用 Outerbridge 分类法对腕骨的关节状况进行分级。
对 15 例 3 期疾病患者进行了评估，其中 5 例根据 Lichtman 分期为 3A 型，10 例为 3B 型。根据 Outerbridge 分类法，月骨沟受影响最严重，3A 期平均为 2.8，3B 期平均为 2.9。其他区域受影响明显较小，平均分别为 1.1 和 1.3。
腕关节镜评估有助于手术决策，能提供更多关于 3 期月骨无菌性坏死软骨状况的细节。
