Botelheiro J C, Silverio Silvia, Neto Ana Luísa
Department of Orthopaedics, Hospital dos Lusiadas, Lisbon, Portugal.
Department of Orthopaedics, Hospital de Sant'Ana, Parede, Portugal.
J Wrist Surg. 2019 Aug;8(4):264-267. doi: 10.1055/s-0039-1688947. Epub 2019 May 28.
To review the results of shortening osteotomies of the radius in our stage IIIB Kienbock's disease patients. In the past 30 years, we treated 52 cases of Kienbock's disease by a shortening osteotomy of the radius, of which 21 already had carpal collapse. All patient charts and X-rays were reviewed, but only the cases already with carpal collapse (stage IIIB) are presented here. All patients improved after surgery. Pain, on a scale of 0 to 3, generally 2 or 3 before surgery (median: 2.3), was normally 1 or 0 afterward (median: 0.9); median flexion-extension of the wrist improved from 77 to 99 degrees; and grip strength of the other hand improved from 26 to 76%. The last clinical and radiological review was performed 1 to 23 years after surgery (median: 8 years). Advanced Kienbock's disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy.
回顾我们治疗的ⅢB期月骨无菌性坏死患者行桡骨缩短截骨术的结果。在过去30年里，我们采用桡骨缩短截骨术治疗了52例月骨无菌性坏死患者，其中21例已出现腕骨塌陷。我们回顾了所有患者的病历和X线片，但这里仅展示已出现腕骨塌陷（ⅢB期）的病例。所有患者术后均有改善。疼痛程度采用0至3分制，术前一般为2或3分（中位数：2.3），术后通常为1或0分（中位数：0.9）；腕关节屈伸活动度中位数从77度提高到99度；对侧手握力从26%提高到76%。最后一次临床和影像学评估在术后1至23年进行（中位数：8年）。伴有腕骨塌陷的晚期月骨无菌性坏死并非保留腕骨手术——桡骨缩短截骨术的禁忌证。
