Wang Patrick Q, Matache Bogdan A, Grewal Ruby, Suh Nina
Department of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada.
Department of Hand and Upper Limb, St. Joseph's Health Care Centre, Roth MacFarlane Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada.
J Wrist Surg. 2020 Dec;9(6):535-548. doi: 10.1055/s-0040-1716353. Epub 2020 Sep 14.
Despite numerous proposed surgical interventions, there is a lack of consensus in the optimal treatment of advanced Kienbock's disease. This study aims to perform a systematic review of the current evidence in the management of Lichtman's stages IIIA and IIIB of the disease. A literature search was performed using the MEDLINE, EMBASE, and COCHRANE databases to identify studies between 2008 and 2018 evaluating stage-specific outcomes in Lichtman's stages IIIA and IIIB. The quality of each included paper was evaluated using the Structured Effectiveness Quality Evaluation Scale (SEQES). Data extracted were stage-specificity, clinical and functional outcomes, and radiographic progression of Lichtman's staging. A total of 1,489 titles were identified. Eighty-three papers were fully reviewed, and 30 articles met eligibility criteria for inclusion. There were 3 low-quality and 27 moderate-quality papers. Surgical techniques reported included decompression surgeries, joint-levelling, and radial wedge osteotomies, revascularization techniques, intracarpal arthrodesis, proximal row carpectomy, arthroplasty, and balloon kyphoplasty. All treatment modalities offered pain relief and improvement in functional outcomes. Compared with proximal row carpectomy, intracarpal arthrodesis, and arthroplasty, nonsalvage procedures provided similar clinical and functional outcomes in both stages, with joint-levelling and radial wedge osteotomies preserving greater range of motion. In this systematic review of Kienbock's disease stages IIIA and IIIB, all treatment modalities provided positive outcomes. In stage IIIB, there is evidence to support nonsalvage procedures, as they produced similar clinical outcomes to salvage procedures that have the advantage of not precluding future treatment options if needed and preserving greater range of motion.
尽管提出了众多手术干预方法，但在晚期月骨无菌性坏死的最佳治疗方案上仍缺乏共识。 本研究旨在对目前关于Lichtman分期为IIIA和IIIB期疾病治疗的证据进行系统综述。 使用MEDLINE、EMBASE和COCHRANE数据库进行文献检索，以确定2008年至2018年期间评估Lichtman分期IIIA和IIIB期特定阶段结果的研究。使用结构化有效性质量评估量表（SEQES）评估每篇纳入论文的质量。提取的数据包括特定阶段、临床和功能结果以及Lichtman分期的影像学进展。 共识别出1489个标题。对83篇论文进行了全面审查，30篇文章符合纳入标准。其中3篇为低质量论文，27篇为中等质量论文。报告的手术技术包括减压手术、关节平整、桡骨楔形截骨术、血管重建技术、腕骨间融合术、近排腕骨切除术、关节成形术和球囊后凸成形术。所有治疗方式均能缓解疼痛并改善功能结果。与近排腕骨切除术、腕骨间融合术和关节成形术相比，非挽救性手术在两个阶段均提供了相似的临床和功能结果，关节平整和桡骨楔形截骨术保留了更大的活动范围。 在对月骨无菌性坏死IIIA和IIIB期的这一系统综述中，所有治疗方式均取得了积极结果。在IIIB期，有证据支持非挽救性手术，因为它们产生的临床结果与挽救性手术相似，且具有在需要时不排除未来治疗选择并保留更大活动范围的优势。
