Fouaad Amro A, Hegazy Galal, Alnahas Mohammed, ElSawy Gamal, Saqr Yasser, Shaheen Elsayed, Gamal Mohamed, Akl Mohamed Nasr, Darweash Ahmed
Al Azhar University, Cairo, Egypt.
Portsaid University, Portsaid, Egypt.
Int Orthop. 2025 May;49(5):1143-1152. doi: 10.1007/s00264-025-06458-8. Epub 2025 Mar 1.
This study aims to evaluate the outcomes of scaphocapitate arthrodesis with lunate excision in patients with stage IIIB and IIIC Kienböck's disease.
Between September 2013 and April 2024, 106 consecutive patients were screened, with 64 consenting to participate. Final analysis included 56 patients (32 stage IIIB and 24 stage IIIC) who underwent scaphocapitate arthrodesis with lunate excision, utilizing distal radius bone grafting stabilized by Herbert compression screws. Preoperative and postoperative assessments (6, 18, 36, and 84 months) included VAS score for pain, ROM, grip strength, MMWS, PRWE scores, and radiographic evaluations including RS angle, CHR, CUDR, and ulnar variance.
The mean operative time was 75 ± 11 min, and the average follow-up was 86 ± 2.5 months. The union rate was 91% with a mean time to union of 10 ± 2 weeks. Preoperative mean VAS scores (63 ± 4 mm) significantly decreased to 25 ± 9 mm at 6 months and 12 ± 4 mm at 36 months (p = 0.001), with a slight increase to 22 ± 5 mm at 84 months. ROM improved from 46% ± 9% of the healthy side preoperatively to 59% ± 3.2% at 36 months (p = 0.001) but slightly decreased to 58% ± 3% at 84 months. Grip strength improved from 48% ± 8% preoperatively to 89% ± 6.4% at 36 months (p = 0.001) and remained stable at 88% ± 4% at 84 months. The mean MMWS increased from 46 ± 7 to 75 ± 5 (p = 0.001), while PRWE scores decreased from 68 ± 8 to 23 ± 6 (p = 0.001). The mean RS angle decreased from 59° ± 8° preoperatively to 50° ± 3° at 36 months (p = 0.001). There was no significant change in CHR (0.44 ± 0.04 to 0.46 ± 0.03, p = 0.251), while CUDR decreased from 31 ± 3 mm to 25 ± 2 mm (p = 0.021). Ulnar variance remained stable (p = 0.325). Degenerative changes were noted in 13 patients (23%) at the RS joint, with six showing Grade I, 5 Grade II, and 1 Grade III degeneration. Additionally, 5 patients (9%) exhibited changes at the STT joint, comprising three with Grade I and 2 with Grade II degeneration.
Scaphocapitate arthrodesis with lunate excision can improves pain, ROM, grip strength, and functional scores in patients with stage IIIB and IIIC Kienböck's disease. Over time, improvements in VAS scores and functional metrics were notable, though there was a slight decline in pain relief and ROM at 84 months. These changes are critical to understanding the potential degenerative complications, particularly at the RS joint, where some patients developed osteoarthritis.
Level II.
本研究旨在评估在IIIB期和IIIC期Kienböck病患者中，行月骨切除舟头关节融合术的疗效。
2013年9月至2024年4月期间，连续筛查了106例患者，其中64例同意参与。最终分析纳入了56例患者（32例IIIB期和24例IIIC期），这些患者接受了月骨切除舟头关节融合术，并采用Herbert加压螺钉固定的桡骨远端植骨。术前和术后评估（6、18、36和84个月）包括疼痛视觉模拟评分（VAS）、活动度（ROM）、握力、梅奥腕部功能评分（MMWS）、患者腕部评价（PRWE）评分，以及包括桡腕角（RS角）、尺月角（CHR）、尺月间隙（CUDR）和尺骨变异的影像学评估。
平均手术时间为75±11分钟，平均随访时间为86±2.5个月。融合率为91%，平均融合时间为10±2周。术前平均VAS评分（63±4mm）在6个月时显著降至25±9mm，在36个月时降至12±4mm（p=0.001），在84个月时略有上升至22±5mm。ROM从术前健侧的46%±9%改善至36个月时的59%±3.2%（p=0.001），但在84个月时略有下降至58%±3%。握力从术前的48%±8%改善至36个月时的89%±6.4%（p=0.001），在84个月时保持稳定，为88%±4%。平均MMWS从46±7增加至75±5（p=0.001），而PRWE评分从68±8降至23±6（p=0.001）。平均RS角从术前的59°±8°降至36个月时的50°±3°（p=0.001）。CHR无显著变化（从0.44±0.04至0.46±0.03，p=0.251），而CUDR从31±3mm降至25±2mm（p=0.021）。尺骨变异保持稳定（p=0.325）。在RS关节发现13例患者（23%）有退变改变，其中6例为I级，5例为II级，1例为III级退变。此外，5例患者（9%）在舟大小多角关节有改变，包括3例I级和2例II级退变。
月骨切除舟头关节融合术可改善IIIB期和IIIC期Kienböck病患者的疼痛、ROM、握力和功能评分。随着时间推移，VAS评分和功能指标有显著改善，尽管在84个月时疼痛缓解和ROM略有下降。这些变化对于理解潜在的退变并发症至关重要，尤其是在RS关节，部分患者出现了骨关节炎。
II级。
