Orthopedic Department, Faculty of Medicine, AL-Azhar University, Nasr City, Cairo, 11884, Egypt.
Orthopedic Department, Faculty of Medicine, Portsaid University, Portfouad, Portsaid, 42526, Egypt.
Arch Orthop Trauma Surg. 2024 Aug;144(8):3875-3884. doi: 10.1007/s00402-024-05423-1. Epub 2024 Jul 15.
The study evaluated the efficacy of SC arthrodesis with lunate preservation for treating patients diagnosed with stage IIIB or IIIC Kienböck's disease, who also exhibit neutral ulnar variance. The study further aimed to explore potential variations in outcomes between patients diagnosed with stage IIIB and IIIC Kienböck's disease.
Thirty-two patients diagnosed with stage IIIB (n = 19) and stage IIIC (n = 13) Kienböck's disease underwent SC arthrodesis with distal radius bone grafting stabilised by Herbert compression screws. All participants underwent pre- and post-operative assessments including VAS score for pain, ROM, grip strength, MMWS, and the Quick DASH score. Additionally, RS angle, LHI ratio, and CHI ratio were assessed.
For all patients, the mean operative time was 73 min, follow-up was 45.6 months, time to union was 14 weeks, and time to full return to work was 24 weeks. The rate of union at the arthrodesis site was 91% (29 out of 32 patients) whilst the incidence of postoperative degenerative arthritis was 36% (8 out of 32 patients). Regarding changes in the means of outcomes from pre- to post-operatively, the VAS score decreased from 8.2 to 1.3 and grip strength improved from 36 to 79%. The RS angle was corrected from 59° to 50°. Significant improvements were noted in the mean MMWS from 45 to 75 and QuickDASH score from 78 to 21. However, no significant changes were observed in ROM, LHI, and CHI. There were no significant differences between patients with stage IIIB and stage IIIC in terms of these parameters, except for differences observed in the RS angle, LHI, and CHI preoperatively and in LHI and CHI postoperatively.
Evidence level: II. Our research demonstrates that SC arthrodesis is a valuable approach for reducing pain, improving grip strength, and enhancing overall function in individuals with advanced Kienböck's disease. Importantly, our results indicate no notable differences in outcomes between patients diagnosed with stage IIIB or IIIC Kienböck's disease.
本研究评估了保留月骨的 SC 关节融合术治疗诊断为 IIIB 或 IIIC 期 Kienböck 病且伴有中立性尺侧偏距的患者的疗效，并探讨了诊断为 IIIB 期和 IIIC 期 Kienböck 病的患者之间结局的潜在差异。
32 例诊断为 IIIB 期（n=19）和 IIIC 期（n=13）Kienböck 病的患者接受了 SC 关节融合术，采用桡骨远端骨移植和 Herbert 压缩螺钉固定。所有患者均接受术前和术后评估，包括疼痛的视觉模拟评分（VAS）、ROM、握力、MMWS 和 QuickDASH 评分，以及 RS 角、LHI 比值和 CHI 比值。
所有患者的平均手术时间为 73 分钟，随访时间为 45.6 个月，融合时间为 14 周，完全恢复工作时间为 24 周。融合部位的融合率为 91%（32 例中有 29 例），术后退行性关节炎的发生率为 36%（32 例中有 8 例）。关于术后从术前到术后结果的均值变化，VAS 评分从 8.2 降至 1.3，握力从 36 提高至 79%。RS 角从 59°校正至 50°。MMWS 从 45 提高至 75，QuickDASH 评分从 78 提高至 21，均值显著提高。但是，ROM、LHI 和 CHI 没有显著变化。在 RS 角、LHI 和 CHI 术前和 LHI 和 CHI 术后方面，III 期和 IIIC 期患者的这些参数没有显著差异，但 RS 角、LHI 和 CHI 术前和 LHI 和 CHI 术后的差异除外。
证据水平：II 级。我们的研究表明，SC 关节融合术是治疗晚期 Kienböck 病患者减轻疼痛、提高握力和增强整体功能的有效方法。重要的是，我们的结果表明，诊断为 IIIB 或 IIIC 期 Kienböck 病的患者之间的结局没有显著差异。
