Song Muguo, Xu Yongqing, He Xiaoqing, Li Chuan
Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China.
Graduate School of Kunming Medical University, Kunming Yunnan, 650500, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Sep 15;38(9):1059-1064. doi: 10.7507/1002-1892.202405049.
To investigate the long-term effectiveness of Ni-Ti memory alloy tripod fixator in the treatment of Kienböck disease.
The clinical data of 22 patients with Kienböck disease who were treated with Ni-Ti memory alloy tripod fixator between January 2011 and September 2013 and followed up more than 10 years was retrospectively analyzed. There were 14 males and 8 females with an average age of 45 years (range, 20-64 years). The Lichtman staging was stage Ⅲb. According to AO/Association for the Study of Internal Fixation (AO/ASIF) classification, there were 6 cases of type B1, 2 cases of type B2, 10 cases of type B3, and 4 cases of type C2. The disease duration ranged from 18 to 50 months, with an average of 30.7 months. The operation time, intraoperative blood loss, and complications were recorded. Wrist height ratio and scapholunate angle were measured by wrist anteroposterior and lateral X-ray films before and after operation. The grip strength of bilateral hands was measured by Jamar dynamometer. The wrist pain was evaluated by visual analogue scale (VAS) score, and the wrist function was evaluated by Mayo score, and the radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion of wrist were measured.
The operation time was 45-60 minutes, with an average of 52.21 minutes; the intraoperative blood loss was 50-60 mL, with an average of 58.63 mL. No nerve or blood vessel injury occurred during operation. All patients were followed up 10-13 years (mean, 11.3 years). X-ray films at 3 months after operation showed that the density of lunate bone was lower than that before operation. Satisfactory fusion of the scapho-trapezio-trapezoeid joint was achieved at 3-6 months after operation (mean, 4.5 months), and the wrist height ratio and the scapholunate angle after fusion significantly improved when compared with those before operation ( <0.05). Wrist pain relieved, scaphoid rotation and dislocation improved, and no radiocarpal joint degeneration was found during follow-up, and no internal fixator loosening, breakage, or lunate bone necrosis occurred. At last follow-up, the wrist radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion, VAS score, and grip strength of the affected side significantly improved when compared with those before operation ( <0.05); the grip strength of the affected side recovered to 99.00%±1.25% of the healthy side. Mayo score ranged from 72 to 93, with an average of 85; 14 cases were rated as excellent, 5 good, and 3 satisfactory, the excellent and good rate was 86.4%.
In the treatment of stage Ⅲb Kienböck's disease, the scapho-trapezio-trapezoeid joint usion using Ni-Ti memory alloy tripod fixator can effectively reduce pain, improve hand function, and prevent further deterioration, and achieve good long-term effectiveness.
探讨镍钛记忆合金三脚架固定器治疗月骨无菌性坏死的长期疗效。
回顾性分析2011年1月至2013年9月采用镍钛记忆合金三脚架固定器治疗且随访时间超过10年的22例月骨无菌性坏死患者的临床资料。其中男性14例，女性8例，平均年龄45岁（20 - 64岁）。Lichtman分期为Ⅲb期。按照AO/内固定研究学会（AO/ASIF）分类：B1型6例，B2型2例，B3型10例，C2型4例。病程18 - 50个月，平均30.7个月。记录手术时间、术中出血量及并发症情况。通过腕关节正侧位X线片测量术前、术后腕高比及舟月角。采用Jamar握力计测量双侧手握力。采用视觉模拟评分法（VAS）评估腕部疼痛，采用Mayo评分评估腕关节功能，并测量腕关节桡偏、尺偏、背伸及掌屈活动度。
手术时间45 - 60分钟，平均52.21分钟；术中出血量50 - 60 mL，平均58.63 mL。术中无神经、血管损伤。所有患者随访10 - 13年（平均11.3年）。术后3个月X线片显示月骨密度低于术前。术后3 - 6个月（平均4.5个月）舟大多角小多角关节融合满意，融合后腕高比及舟月角较术前显著改善（<0.05）。随访期间腕部疼痛缓解，舟骨旋转及脱位改善，未见桡腕关节退变，未出现内固定松动、断裂及月骨坏死。末次随访时，患侧腕关节桡偏、尺偏、背伸及掌屈活动度、VAS评分及握力较术前显著改善（<0.05）；患侧握力恢复至健侧的99.00%±1.25%。Mayo评分72 - 93分，平均85分；优14例，良5例，可3例，优良率为86.4%。
应用镍钛记忆合金三脚架固定器行舟大多角小多角关节融合治疗Ⅲb期月骨无菌性坏死，可有效减轻疼痛，改善手部功能，防止病情进一步恶化，长期疗效良好。
