Saeki Masaomi, Yamamoto Michiro, Tatebe Masahiro, Kurimoto Shigeru, Yoneda Hidemasa, Hirata Hitoshi
Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
J Plast Reconstr Aesthet Surg. 2022 Aug;75(8):2831-2870. doi: 10.1016/j.bjps.2022.04.016. Epub 2022 Apr 23.
Although good clinical results have been reported following lunate resection and vascularized os pisiform transfer for advanced stages of Kienböck's disease, the occurrence of wrist osteoarthritis has been highlighted. We aimed to investigate the postoperative condition of the pisiform and the surrounding bones in patients who underwent surgery for advanced stages of Kienböck's disease using magnetic resonance imaging. We retrospectively reviewed the data of six patients (mean age, 45 years; Lichtman stage, IIIb) who underwent lunate resection and vascularized os pisiform transfer for advanced stages of Kienböck's disease and postoperative magnetic resonance imaging examination. We extracted clinical data on pre- and postoperative range of motion, grip strength, wrist pain, Hand20 and Lichtman's criteria, and pre- and postoperative radiographic and magnetic resonance imaging examinations. Bone marrow lesions in the transferred pisiform were found in five patients. Signal changes of bones around the transferred pisiform were found in these five patients; the greatest change was observed in the capitate bone in three patients. These signal changes were found in the opposite parts of the bones around the transferred pisiform. No patient exhibited signal changes in the transferred pisiform bone only. Wrist osteoarthritis after lunate resection and vascularized os pisiform transfer for advanced stages of Kienböck's disease is more likely to be attributed to the low congruency of the transferred pisiform and surrounding bones than to the compromised perfusion of the pisiform. Signal changes in the opposite bone parts around the transferred pisiform were confirmed in all patients with signal changes in the pisiform.
尽管对于晚期月骨无菌性坏死，月骨切除联合带血管蒂豌豆骨移植术后已报道有良好的临床效果，但腕关节骨关节炎的发生已受到关注。我们旨在利用磁共振成像研究接受晚期月骨无菌性坏死手术患者术后豌豆骨及周围骨骼的情况。我们回顾性分析了6例（平均年龄45岁；Lichtman分期为IIIb期）接受月骨切除联合带血管蒂豌豆骨移植治疗晚期月骨无菌性坏死及术后磁共振成像检查患者的数据。我们提取了术前和术后的活动范围、握力、腕部疼痛、Hand20和Lichtman标准等临床数据，以及术前和术后的影像学及磁共振成像检查结果。5例患者在移植的豌豆骨中发现骨髓病变。这5例患者在移植的豌豆骨周围骨骼发现信号改变；3例患者头状骨信号改变最为明显。这些信号改变见于移植豌豆骨周围骨骼的相对部位。没有患者仅在移植的豌豆骨中出现信号改变。对于晚期月骨无菌性坏死，月骨切除联合带血管蒂豌豆骨移植术后的腕关节骨关节炎更可能归因于移植的豌豆骨与周围骨骼的低匹配度，而非豌豆骨灌注受损。在豌豆骨有信号改变的所有患者中，均证实移植豌豆骨周围相对部位的骨骼有信号改变。
