Department of Orthopaedics and Traumatology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basın Sitesi, 35360 Karabaglar, Izmir, Turkey.
Department of Orthopaedics and Traumatology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basın Sitesi, 35360 Karabaglar, Izmir, Turkey.
Hand Surg Rehabil. 2021 Sep;40(4):427-432. doi: 10.1016/j.hansur.2021.03.004. Epub 2021 Mar 26.
This study aimed to compare medium-term results for partial capitate shortening (PCS) and radial shortening (RS) osteotomies on lunate bone revascularization and disease progression in patients with stage II or IIIA Kienböck's disease. Patients who underwent surgery for Kienböck's disease between March 2010 and July 2020 were retrospectively evaluated. Clinical evaluation included assessment of pain, joint range of motion, strength, DASH, visual analog scale (VAS) for pain, Modified Mayo Wrist Score (MMWS), satisfaction and time to return to work, with comparison as appropriate to the contralateral side. Preoperative and postoperative plain radiographs and magnetic resonance imaging (MRI) were used for radiological evaluation. Lichtman staging and signal changes in the lunate were evaluated using MRI. Group 1 (PCS) included 14 patients and Group 2 (RS) 14. Mean follow-up was 57.8 months (range 24-102) in Group 1 and 49.4 months (range 36-73) in Group 2. Clinical evaluation included pain on VAS, DASH score, MMWS, range of motion, and grip, palmar and key pinch strength. Regarding lunate bone vascularization, increased signal on final follow-up MRI was observed in 10 of the 14 patients in Group 1 and 7 of the 14 patients in Group 2. There was a positive correlation between revascularization and final follow-up MMWS (p = 0.006). The present study thus showed that functional scores were improved by revascularization in Kienböck's disease. Both osteotomies had clinically and radiologically satisfactory results. However, we believe that PCS osteotomy is preferable, as it leads to higher revascularization rates without increasing ulnolunate load.
本研究旨在比较部分头状骨缩短（PCS）和桡骨缩短（RS）截骨术对头状骨血运重建和 II 期或 IIIA 期月骨骨软骨病患者疾病进展的中期结果。回顾性评估了 2010 年 3 月至 2020 年 7 月期间因月骨骨软骨病接受手术的患者。临床评估包括疼痛、关节活动范围、力量、DASH、疼痛视觉模拟量表（VAS）、改良 Mayo 腕关节评分（MMWS）、满意度和重返工作岗位的时间，并适当与对侧进行比较。使用术前和术后的平片和磁共振成像（MRI）进行影像学评估。使用 MRI 评估 Lichtman 分期和月骨信号变化。第 1 组（PCS）包括 14 例患者，第 2 组（RS）包括 14 例患者。第 1 组的平均随访时间为 57.8 个月（范围 24-102），第 2 组为 49.4 个月（范围 36-73）。临床评估包括 VAS 疼痛评分、DASH 评分、MMWS、关节活动范围以及握力、掌侧和指尖捏力。关于月骨的血管化，第 1 组 14 例患者中有 10 例和第 2 组 14 例患者中有 7 例在末次随访时 MRI 上观察到信号增加。血管化与末次随访时的 MMWS 呈正相关（p=0.006）。本研究表明，在月骨骨软骨病中，血管化可改善功能评分。两种截骨术均有临床和影像学满意的结果。然而，我们认为 PCS 截骨术更可取，因为它可提高血运重建率，而不会增加尺月负荷。
