Eiken O, Necking L E
Scand J Plast Reconstr Surg. 1984;18(2):247-52. doi: 10.3109/02844318409052846.
The results of lunate implant arthroplasty are unpredictable and many untoward postoperative problems are encountered. A retrospective review of 19 patients operated on for lunatomalacia (Kienböck's disease) by Silastic (HP) implant arthroplasty suggests that prevention of postoperative scapholunate dissociation seems to be the key to successful results. Knowledge of the predominant role played by the palmar ulnolunate and radiolunate ligaments is important to the understanding of this mechanism. The intrinsic stability accomplished by the geometry of the carpal bones requires adequate ligamentous support. This restraint, however, may be weakened by pre-existing absence of certain palmar fibres, by the disease process or by the surgery. In the present study three operative methods have been assessed: dorsal approach and implant stem fixation; dorsal approach, removal of implant stem and Kirschner-wire fixation; volar approach, removal of implant stem, no internal fixation but palmar capsuloligamentous reinforcement. Consistently good results have been obtained using the latter technique. It seems as if most of the usual postoperative problems of lunate implant arthroplasty can be avoided by this method which warrants continued trial.
月骨植入关节成形术的结果不可预测，术后会出现许多不良问题。对19例因月骨软化症（Kienböck病）接受硅橡胶（HP）植入关节成形术的患者进行的回顾性研究表明，预防术后舟月关节分离似乎是取得成功结果的关键。了解掌侧尺月韧带和桡月韧带所起的主要作用对于理解这一机制很重要。腕骨几何形状实现的内在稳定性需要足够的韧带支持。然而，这种限制可能会因某些掌侧纤维预先缺失、疾病过程或手术而减弱。在本研究中，评估了三种手术方法：背侧入路和植入物柄固定；背侧入路、移除植入物柄和克氏针固定；掌侧入路、移除植入物柄、不进行内固定但进行掌侧关节囊韧带加强。使用后一种技术一直取得了良好的效果。似乎通过这种方法可以避免月骨植入关节成形术大多数常见的术后问题，值得继续试验。
