Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Mechanical Engineering, Sejong University, Seoul, Republic of Korea.
Orthop Surg. 2023 Sep;15(9):2477-2481. doi: 10.1111/os.13776. Epub 2023 Jun 22.
Idiopathic avascular necrosis of the lunate is known as Kienböck's disease and that of the scaphoid is known as Preiser's disease. Because the prevalence of coexisting Kienböck's and Preiser's diseases is very low, standardized stages of disease and treatments are not established.
We report coexisting avascular necrosis of the scaphoid and lunate in a 68-year-old woman with no history of steroids or other risk factors. We treated her with proximal row carpectomy with capsular interposition technique. A distal-based dorsal capsular flap was prepared and repaired the palmar capsule. At the last follow-up, she had no pain and had gained improved range of wrist motion. There was no arthritic change at the newly formed radiocapitate joint.
In the case of collapsed lunate and scaphoid with avascular necrosis, the proximal row carpectomy procedure has an advantage. Proximal row carpectomy with dorsal capsular interposition can be performed when the lunate or scaphoid cannot be saved. Arthritic changes of the capitate head and distal radius lunate facet can be covered with the dorsal capsule.
月骨特发性无菌性坏死又被称为 kienböck 病，舟骨特发性无菌性坏死又被称为 Preiser 病。由于 kienböck 病和 Preiser 病同时存在的患病率非常低，因此尚未建立标准化的疾病分期和治疗方法。
我们报告了一例 68 岁女性同时患有月骨和舟骨无菌性坏死，无类固醇或其他危险因素史。我们采用近端桡腕关节切除术联合囊内间隔技术对其进行治疗。制备了一个基于远侧的背侧囊瓣，并修复了掌侧囊。末次随访时，患者无疼痛，腕关节活动度改善。新形成的头状骨-桡骨远端月骨关节无关节炎改变。
对于月骨和舟骨塌陷伴无菌性坏死的病例，行近端桡腕关节切除术有优势。当月骨或舟骨无法保留时，可以行近端桡腕关节切除术联合背侧囊内间隔。背侧囊可以覆盖头状骨头部和桡骨远端月骨关节面的关节炎改变。
