Gezer Mehmet Can, Bezirgan Uğur, Yoğun Yener, Ünsal Seyit Şerif, Armangil Mehmet
Acta Orthop Traumatol Turc. 2025 Mar 17;59(1):33-38. doi: 10.5152/j.aott.2025.24046.
This study aimed to compare the clinical results and determine functional superiority in patients treated with scaphocapitate fusion (SCF) versus proximal row carpectomy (PRC) for advanced-grade Kienböck disease.
The patients were assessed in terms of demographic data, follow-up duration, disease stage, preoperative and final follow-up values of the disability of arm, shoulder, and hand (DASH) score, patient-rated wrist evaluation (PRWE) score, and visual analog scale (VAS) pain score, together with the key-pinch grip and palmar grip values. The preoperative and postoperative flexion and extension angles and radial and ulnar deviation angles were also recorded and compared. As there were no records of preoperative grip strength values, comparisons were made with the healthy contralateral hand.
A total of 26 patients were evaluated, including 10 who underwent PRC surgery and 16 who underwent SCF. Preoperatively, the flexion range was 65.8% in the PRC group and 58.8% in the SCF group, the extension range was 65.8% and 56.7%, radial deviation was 35% and 40.6%, and ulnar deviation was 65% and 61.1%, respectively. Postoperatively, the mean values of these parameters were comparable between the 2 groups. When grip strength was compared with the non-operated hand, it was determined to be 58.8% of the healthy hand in the PRC group and 60.9% in the SCF group. Similarly, pinch strength was 45.5% of the healthy hand in the PRC group and 55.6% in the SCF group. In all patients, a statistically significant reduction was observed in postoperative DASH, PRWE, and VAS scores compared to preoperative values. Specifically, in the PRC group, the postoperative scores were DASH: 22.6, PRWE: 43.6, and VAS: 3.2, while in the SCF group, the corresponding values were DASH: 26.5, PRWE: 38.2, and VAS: 2.9.
In advanced-grade Kienböck disease, PRC appears to be a more favorable option when preserving joint range of motion is a priority, whereas SCF may provide better outcomes in terms of grip strength. Both techniques seem to o!er comparable pain relief and functional results, suggesting that the choice of procedure should be tailored to the patient's individual needs and priorities.
Level IV, Therapeutic Study.
本研究旨在比较舟月骨融合术（SCF）与近排腕骨切除术（PRC）治疗晚期Kienböck病患者的临床结果，并确定功能优势。
对患者的人口统计学数据、随访时间、疾病分期、术前和末次随访时的手臂、肩部和手部功能障碍（DASH）评分、患者自评腕关节评估（PRWE）评分、视觉模拟量表（VAS）疼痛评分，以及捏力和握力值进行评估。还记录并比较了术前和术后的屈伸角度以及桡尺偏斜角度。由于术前握力值没有记录，因此与健侧对侧手进行比较。
共评估了26例患者，其中10例行PRC手术，16例行SCF手术。术前，PRC组的屈曲范围为65.8%，SCF组为58.8%；伸展范围分别为65.8%和56.7%；桡偏分别为35%和40.6%；尺偏分别为65%和61.1%。术后，两组这些参数的平均值相当。当将握力与未手术手进行比较时，PRC组为健侧手的58.8%，SCF组为60.9%。同样，捏力在PRC组为健侧手的45.5%，SCF组为55.6%。在所有患者中，术后DASH、PRWE和VAS评分与术前值相比均有统计学意义的降低。具体而言，PRC组术后评分为DASH：22.6，PRWE：43.6，VAS：3.2，而SCF组相应值为DASH：26.5，PRWE：38.2，VAS：2.9。
在晚期Kienböck病中，当优先保留关节活动范围时，PRC似乎是更有利的选择，而SCF在握力方面可能提供更好的结果。两种技术似乎都能提供相当的疼痛缓解和功能结果，这表明手术方式的选择应根据患者的个体需求和优先事项进行调整。
IV级，治疗性研究。
