Forrester Lynn Ann, Tedesco Liana J, Geiger Bryanna, Strauch Robert J
Hospital for Special Surgery, Department of Hand Surgery, 535 East 70th Street, New York, NY, United States.
Columbia University Medical Center/New York Presbyterian Hospital, Department of Orthopedic Surgery, 622 West 168th Street, PH-11 Center, New York, NY, United States.
J Hand Microsurg. 2024 Oct 10;17(1):100168. doi: 10.1016/j.jham.2024.100168. eCollection 2025 Jan.
The definitive treatment of Kienbock's disease has yet to be determined. Wrist denervation combined with core decompression of the radius has not been previously studied as a combined treatment for Kienbock's disease.
The purpose of this study was to assess the efficacy of simultaneous wrist denervation and core decompression of the radius in the treatment of Kienbock's disease.
All patients with Kienbock's disease who were treated with simultaneous core decompression of the radius and wrist denervation by a single surgeon at a single institution from 2012 to 2022 were contacted for this study. Demographic, clinical and radiographic data were collected retrospectively. Quick DASH and Upper Extremity PROMIS scores were collected prospectively.
Ten patients met inclusion criteria. Mean age at time of surgery was 31 years old. One patient was Lichtman stage 2, 5 patients were stage 3a, and 4 patients were stage 3 b. Patient reported outcomes were collected at a mean of 5.1 years since surgery (7 month-10.3 years). The mean Upper Extremity Promise T-score was 49 (median 52; age >/ = 40, normal 51.2 ± 8.2; age <40, normal 55.9 ± 6.6) and the mean Quick DASH score was 13 (median 7; normal 0-20). Nine of 10 patients reported they were satisfied with the procedure, and 100 % of patients said they would choose to have the procedure again.
Patients with Lichtman stage 2, 3a and 3 b Kienbock's disease treated with simultaneous core decompression and wrist denervation reported minimal to no disability at 5 years after surgery. All patients in this study reported they would choose to have the surgery again to treat their Kienbock's disease.
月骨无菌性坏死的确定性治疗方法尚未确定。腕部去神经支配联合桡骨核心减压作为月骨无菌性坏死的联合治疗方法，此前尚未有研究。
本研究旨在评估腕部去神经支配与桡骨核心减压同时进行治疗月骨无菌性坏死的疗效。
本研究联系了2012年至2022年在单一机构由同一位外科医生同时进行桡骨核心减压和腕部去神经支配治疗的所有月骨无菌性坏死患者。回顾性收集人口统计学、临床和影像学数据。前瞻性收集快速DASH和上肢PROMIS评分。
10例患者符合纳入标准。手术时的平均年龄为31岁。1例患者为Lichtman 2期，5例为3a期，4例为3b期。患者报告的结果收集于术后平均5.1年（7个月至10.3年）。上肢PROMIS平均T评分为49（中位数52；年龄≥40岁，正常为51.2±8.2；年龄<40岁，正常为55.9±6.6），快速DASH平均评分为13（中位数7；正常为0 - 20）。10例患者中有9例报告对手术满意，100%的患者表示会再次选择进行该手术。
同时接受核心减压和腕部去神经支配治疗的Lichtman 2期、3a期和3b期月骨无菌性坏死患者在术后5年报告的残疾程度极小或无残疾。本研究中的所有患者均表示会再次选择进行该手术来治疗其月骨无菌性坏死。
