Yokota Takeru, Ejiri Soichi, Sasaki Nobuyuki, Akiyama Yuto, Toshiki Narihiro, Kameda Takuya, Matsumoto Yoshihiro
Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
Department of Orthopedic Surgery, Iwaki City Medical Center, Iwaki, Japan.
JB JS Open Access. 2024 Oct 30;9(4). doi: 10.2106/JBJS.OA.24.00066. eCollection 2024 Oct-Dec.
Age is a preoperative prognostic factor for radial closing wedge osteotomy (RCWO) in Kienbock disease. Specifically, for cases classified as Lichtman stage III, clear criteria for selecting RCWO have not been established. We believe that age can provide vital information for determining the appropriate surgical procedure for Kienbock disease. The aim of this study was to investigate RCWO outcomes for Lichtman stage III by examining different age groups from clinical and radiological perspectives.
Sixteen patients with Lichtman stage III Kienbock disease underwent RCWO. The median age was 59 years, and the median follow-up period was 2.9 years. We determined the age cutoffs for clinical and radiological outcomes using a receiver operating characteristic curve. Subsequently, we conducted intergroup comparisons of postoperative outcomes between the younger and older age groups.
Age cutoffs were established at 52.5 and 30 years for clinical and radiological outcomes, respectively. In the comparative analysis, the younger age group (≤52 years; n = 7) demonstrated significantly superior clinical results, including improved range of motion and pain relief, higher postoperative Mayo Wrist Score, and lower Disability of the Arm, Shoulder, and Hand scores. From a radiological perspective, the younger age group (≤30 years; n = 3) experienced segmented lunate bone fragments healing, indicating an improved disease stage compared with the older group.
Based on previous literature and our research findings, it is reasonable to conclude that RCWO results in improved clinical outcomes for patients up to their mid-50s and enhanced radiological outcomes for those up to approximately at the age of 30 years. Further studies on these age cutoffs will contribute to refining the surgical selection criteria for RCWO.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
年龄是月骨无菌性坏死行桡骨闭合楔形截骨术（RCWO）的术前预后因素。具体而言，对于Lichtman III期病例，尚未确立选择RCWO的明确标准。我们认为年龄可为确定月骨无菌性坏死的合适手术方式提供重要信息。本研究的目的是从临床和影像学角度，通过检查不同年龄组，探讨Lichtman III期的RCWO结果。
16例Lichtman III期月骨无菌性坏死患者接受了RCWO。中位年龄为59岁，中位随访期为2.9年。我们使用受试者工作特征曲线确定临床和影像学结果的年龄临界值。随后，我们对年轻和老年年龄组的术后结果进行了组间比较。
临床和影像学结果的年龄临界值分别确定为52.5岁和30岁。在比较分析中，较年轻年龄组（≤52岁；n = 7）显示出明显更好的临床结果，包括活动范围改善和疼痛缓解、术后梅奥腕关节评分更高以及手臂、肩部和手部残疾评分更低。从影像学角度看，较年轻年龄组（≤30岁；n = 3）出现了月骨节段性骨块愈合，表明与老年组相比疾病阶段有所改善。
基于既往文献和我们的研究结果，合理的结论是RCWO可使50多岁以下患者的临床结果得到改善，使30岁左右以下患者的影像学结果得到改善。关于这些年龄临界值的进一步研究将有助于完善RCWO的手术选择标准。
预后IV级。有关证据水平的完整描述，请参阅作者须知。
