Lichtman David M, Pientka William F
Department of Surgery, School of Medicine, Uniformed Services University, Bethesda, Maryland.
Department of Orthopaedic Surgery, JPS Health Network, Fort Worth, Texas.
J Bone Joint Surg Am. 2025 May 8;107(12):1389-1402. doi: 10.2106/JBJS.24.01090.
➢ An at-risk lunate (due to anatomic factors) subjected to a trigger event (axial load, embolism, hypercoagulability) leads to the development of lunate osteonecrosis.➢ Children, adolescents, and elderly patients with Kienböck disease respond well to nonoperative treatments, and this should be considered before any surgical intervention.➢ For disease limited to the lunate, treatment decisions should be driven by the condition of the cartilage; intact lunate cartilage can be treated with joint leveling or core decompression, whereas disrupted cartilage surfaces should be bypassed with scaphocapitate or scaphotrapeziotrapezoid arthrodesis. Newer surgical procedures such as wrist arthroscopy and the introduction of contrast-enhanced magnetic resonance imaging have expanded the treatment options for these patients.➢ Once disease extends outside of the lunate, reconstruction with proximal row carpectomy or partial or total wrist arthrodesis should be considered on the basis of which articular surfaces are affected.➢ The new unified classification system and treatment are applicable to almost all patients with Kienböck disease.
➢ （由于解剖因素）处于风险中的月骨受到触发事件（轴向负荷、栓塞、高凝状态）影响会导致月骨缺血性坏死的发生。
➢ 患有月骨无菌性坏死的儿童、青少年和老年患者对非手术治疗反应良好，在进行任何手术干预之前都应考虑这一点。
➢ 对于局限于月骨的疾病，治疗决策应取决于软骨的状况；月骨软骨完整时可采用关节平整或髓芯减压治疗，而软骨表面受损时应采用舟头或舟大多角小多角关节融合术绕过。腕关节镜检查和引入对比增强磁共振成像等新的手术方法扩大了这些患者的治疗选择。
➢ 一旦疾病扩展至月骨以外，应根据受影响的关节面考虑采用近排腕骨切除术或部分或全腕关节融合术进行重建。
➢ 新的统一分类系统和治疗方法适用于几乎所有月骨无菌性坏死患者。
