Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2023 Aug;15(4):643-652. doi: 10.4055/cios22307. Epub 2023 May 26.
This systematic literature review compared long-term outcomes between nonoperative treatment and vascularized bone graft (VBG) in patients with Kienböck disease.
We systematically reviewed studies on nonoperative treatment and VBG for Kienböck disease with a mean follow-up of ≥ 5 years. A systematic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Embase databases to select relevant articles. Data on patient demographics, treatment details, and outcomes were extracted.
Twelve studies (6 for nonoperative treatment and 6 for VBG) were included. The proportion of wrists showing worsening Lichtman stages after treatment was 40.2% (95% confidence interval [CI], 25.7-56.6) and 17.0% (95% CI, 10.2%-26.9%) in the nonoperative treatment group and VBG group, respectively. No change in the stage was observed in 52.4% (95% CI, 25.5%-78.0%) and 77.8% (95% CI, 66.7%-86.0%) of the wrists in the nonoperative treatment group and VBG group, respectively. The proportion of wrists without pain at the final follow-up was 29.2% (95% CI, 16.6%-46.1%) and 35.9% (95% CI, 22.6%-52.0%) in the nonoperative treatment group and VBG group, respectively. The proportion of wrists with more than a moderate degree was 30.4% (95% CI, 22.7%-39.4%) and 12.9% (95% CI, 5.5%-27.4%) in the nonoperative treatment group and VBG group, respectively. The 95% CIs of the mean wrist range of motion and mean grip strength ratio of the affected side to the contralateral side substantially overlapped in the two groups.
The VBG group showed greater improvement in the radiographic stage and wrist pain than did the nonoperative treatment group after treatment, but meaningful differences in parameters were not observed. Further well-designed studies are needed to confirm the superiority of VBG to nonoperative treatment regarding radiographic and clinical outcomes.
本系统文献回顾比较了非手术治疗与带血管骨移植（VBG）治疗月骨缺血性坏死的长期疗效。
我们系统地检索了关于非手术治疗和 VBG 治疗月骨缺血性坏死的研究，这些研究的随访时间均≥5 年。在 Cochrane 中央对照试验注册库（CENTRAL）、PubMed 和 Embase 数据库中进行了系统检索，以选择相关文章。提取患者人口统计学、治疗细节和结局数据。
共纳入 12 项研究（非手术治疗 6 项，VBG 治疗 6 项）。治疗后，影像学 Lichtman 分期恶化的手腕比例分别为非手术治疗组 40.2%（95%置信区间 [CI]：25.7%56.6%）和 VBG 组 17.0%（95%CI：10.2%26.9%）。非手术治疗组和 VBG 组中，影像学分期无变化的手腕比例分别为 52.4%（95%CI：25.5%78.0%）和 77.8%（95%CI：66.7%86.0%）。末次随访时无疼痛的手腕比例分别为非手术治疗组 29.2%（95%CI：16.6%46.1%）和 VBG 组 35.9%（95%CI：22.6%52.0%）。手腕中存在中度以上疼痛的比例分别为非手术治疗组 30.4%（95%CI：22.7%39.4%）和 VBG 组 12.9%（95%CI：5.5%27.4%）。两组间患侧腕关节活动度和握力比值的 95%CI 大部分重叠。
与非手术治疗相比，VBG 治疗在影像学分期和腕关节疼痛方面有较大改善，但在参数上无显著差异。需要进一步设计良好的研究来证实 VBG 在影像学和临床结局方面优于非手术治疗。
