Department of Orthopedics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Department of Orthopedics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
J Hand Surg Am. 2024 Nov;49(11):1143.e1-1143.e7. doi: 10.1016/j.jhsa.2023.02.011. Epub 2023 Mar 25.
This study evaluated the mid-term functional and radiological results of arthroscopic lunate core decompression for treating Kienböck disease.
In a prospective cohort study, 40 patients with a confirmed diagnosis of Kienböck disease (Lichtman stages II to IIIb) underwent arthroscopic core decompression of the lunate bone. A cutting bur was used through the trans-4 portal with visualization from the 3-4 portal after synovectomy and debridement of radiocarpal joint using a shaver from the 6R portal. Disabilities of Arm, Shoulder, and Hand and visual analog scale scores, wrist range of motion, grip strength, radiological changes of Lichtman classification, carpal height ratio, and scapholunate angle were evaluated before and two years after the surgery.
The mean of Disabilities of Arm, Shoulder, and Hand score improved from 52.5 ± 13 to 29.2 ± 16.3. The visual analog scale score also improved from 7.6 ± 1.8 to 2.7 ± 1.9. There was also an improvement in hand grip strength from 6.6 ± 2.7 kg to 12.3 ± 3.1 kg. Wrist range of motion in flexion, extension, ulnar deviation, and radial deviation improved significantly. Lichtman classification remained the same in 36 (90%) patients. Carpal height did not change. Intergroup evaluation showed no functional difference in response to surgery for different radiological Lichtman stages. More improvement was observed in patients with Lichtman stage II, but was not statistically significant.
Arthroscopic lunate core decompression appears to be an effective and safe surgery for treating Kienböck disease on the basis of mid-term follow-up.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究评估了关节镜下月骨核心减压术治疗月骨缺血性坏死的中期功能和影像学结果。
在一项前瞻性队列研究中，40 例经确诊的月骨缺血性坏死患者（Lichtman 分期 II 至 IIIb 期）接受了关节镜下月骨骨芯减压术。在滑膜切除术和桡腕关节清创术后，使用切割钻头通过 4 号前侧入路，在使用滑膜刀通过 6R 号后侧入路从桡侧进入 3-4 号前侧入路进行可视化。在手术前和手术后两年，分别评估了患者的上肢、肩部和手部功能障碍（DASH）评分和视觉模拟量表（VAS）评分、腕关节活动度、握力、Lichtman 分类的影像学变化、腕骨高度比和舟月角。
DASH 评分从 52.5 ± 13 分改善至 29.2 ± 16.3 分，VAS 评分从 7.6 ± 1.8 分改善至 2.7 ± 1.9 分，手的握力从 6.6 ± 2.7kg 改善至 12.3 ± 3.1kg。腕关节的屈伸、尺偏和桡偏活动度均显著改善。Lichtman 分类在 36 例（90%）患者中保持不变。腕骨高度没有变化。组间评估显示，对于不同的放射学 Lichtman 分期，手术治疗的功能差异无统计学意义。Lichtman 分期 II 期的患者观察到更多的改善，但无统计学意义。
基于中期随访，关节镜下月骨核心减压术似乎是治疗月骨缺血性坏死的一种有效且安全的手术方法。
研究类型/证据水平：治疗性 IV 级。
