头状骨缩短截骨术联合或不联合带血管骨移植治疗早期月骨缺血性坏死。
Capitate shortening osteotomy with or without vascularized bone grafting for the treatment of early stages of Kienböck's disease.
机构信息
Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr CityCairo, 11884, Egypt.
Orthopedic Department, Faculty of Medicine, AL-Azhar University, Assiut CityAssiut, 71524, Egypt.
出版信息
Int Orthop. 2021 Oct;45(10):2635-2641. doi: 10.1007/s00264-021-05103-4. Epub 2021 Jul 15.
PURPOSE
The study evaluates the procedures of capitate shortening osteotomy with or without vascularized bone grafting (VBG) for the treatment of stage II or IIIA Kienböck's disease with neutral ulnar variance.
METHOD
Forty-five patients with stage II (n = 21) and IIIA (n = 24) Kienböck's disease were included in the study. Patients were classified into two groups; isolated capitate shortening (ICS) group included 21 patients (stage II [n = 10] and stage IIIA [n = 11]) treated by capitate shortening without VBG of the lunate. Combined capitate shortening (CCS) group includes 24 patients (stage II [n = 11] and stage IIIA [n = 13]) who treated by capitate shortening combined with VBG of the lunate from the dorsal distal radius based on the fourth + fifth extensor compartment artery. All patients were evaluated pre- and post-operative for pain as measured by visual analogue scale score (VAS), range of motion (ROM), grip strength, modified Mayo wrist score (MMWS), lunate height index (LHI) ratio, and carpal height index (CHI) ratio.
RESULTS
The mean operative time for CCS procedure was 85 min (76 to 120) and for ICS was 58 min (47 to 65). The mean follow-up period for all patients was 33 months (29 to 47). Patients with stage IIIA Kienböck's disease treated by CCS procedure had better post-operative VAS, ROM, grip strength, MMWS, LHI, and CHI ratio than patients treated by ICS procedure. ICS procedure reported 28% failure rate versus 8% for CCS. No differences were found between CCS and ICS procedures in patients with stage II Kienböck's disease in the term of clinical, radiographic outcomes, or failure rate.
CONCLUSION
Using CCS procedure for the treatment of stage IIIA Kienböck's disease (lunate height collapse) with neutral ulnar variance can restore height and dimensions of the collapsed lunate and subsequently improve the final outcomes with lower failure rate. However, in patients with stage II Kienböck's disease (maintained lunate height), no advantages were noticed for CCS over ICS procedure. Lunate height index might be considered a prognostic factor for the treatment outcomes of Kienböck's disease.
目的
本研究评估了伴有或不伴有血管化骨移植（VBG）的头状骨缩短截骨术治疗伴有中立性尺侧偏距的 II 期或 IIIA 期 Kienböck 病的手术过程。
方法
研究纳入了 45 例 II 期（n=21）和 IIIA 期（n=24）Kienböck 病患者。患者分为两组；单纯头状骨缩短（ICS）组包括 21 例患者（II 期[n=10]和 IIIA 期[n=11]），行头状骨缩短但不进行舟骨 VBG。联合头状骨缩短（CCS）组包括 24 例患者（II 期[n=11]和 IIIA 期[n=13]），通过第四+第五伸肌间隔动脉从背侧远端桡骨向舟骨行头状骨缩短联合 VBG。所有患者均接受术前和术后疼痛评估，采用视觉模拟评分（VAS）、活动范围（ROM）、握力、改良 Mayo 腕关节评分（MMWS）、月骨高度指数（LHI）比值和腕骨高度指数（CHI）比值。
结果
CCS 组的平均手术时间为 85 分钟（76 至 120 分钟），ICS 组为 58 分钟（47 至 65 分钟）。所有患者的平均随访时间为 33 个月（29 至 47 个月）。CCS 组治疗的 IIIA 期 Kienböck 病患者术后 VAS、ROM、握力、MMWS、LHI 和 CHI 比值均优于 ICS 组。ICS 组的失败率为 28%，而 CCS 组为 8%。CCS 组和 ICS 组治疗 II 期 Kienböck 病患者在临床、影像学结果或失败率方面均无差异。
结论
对于伴有中立性尺侧偏距的 IIIA 期 Kienböck 病（月骨塌陷），采用 CCS 手术治疗可恢复塌陷月骨的高度和尺寸，从而改善最终结果，降低失败率。然而，对于 II 期 Kienböck 病（月骨高度保持正常）患者，CCS 组与 ICS 组相比，并无优势。月骨高度指数可能是 Kienböck 病治疗结果的预后因素。
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