Schmitt E, Hassinger M, Mittelmeier H
Z Orthop Ihre Grenzgeb. 1984 Sep-Oct;122(5):643-50. doi: 10.1055/s-2008-1045044.
The malazie of the Os lunatum ist one of the most frequent aseptic bone-necroses. It is found mainly with patients between the age of 25 and 35 years. That means that most of our patients are working full time. We give a clinical report of the disease and discuss the different aetiopathogenetic mechanisms according to the literature. In addition we give a cronological survey over possible methods of treatment both conservative and operative. We describe our method of treatment introduced by Mittelmeier (1965). In this method the gap that arises by resection of the Os lunatum is filled with a helved piece of soft tissue. This filling-material consists of a volar helved piece of the joint-capsula and of epitendinosus tissue of the deep flexor-tendons. In the Orthopaedic University Hospital in Homburg/Saar we have a casuistic of 42 cases treated by this method. This is the biggest casuistic in the literature as fare as we know. We report our results of treatment based an a clinical and X-ray examination. With this method we had satisfying longterm results in 80% of the cases. Even after years we hardly found an arthrosis between Os naviculare and radius. According to these results we recommend the method after Mittelmeier for the treatment of the malazie of the Os lunatum even for severe cases with fragmentation and collaps of the Os lunatum.
月骨无菌性坏死是最常见的无菌性骨坏死之一。主要见于25至35岁的患者。这意味着我们的大多数患者都在全职工作。我们给出该疾病的临床报告，并根据文献讨论不同的病因发病机制。此外，我们按时间顺序综述了保守和手术治疗的可能方法。我们描述了由米特尔迈尔（1965年）提出的治疗方法。在这种方法中，切除月骨后产生的间隙用一块减半的软组织填充。这种填充材料由关节囊掌侧减半的部分和屈指深肌腱的腱旁组织组成。在萨尔洪堡的骨科大学医院，我们有42例采用这种方法治疗的病例。据我们所知，这是文献中最大的病例数。我们根据临床和X线检查报告治疗结果。采用这种方法，80%的病例取得了令人满意的长期效果。即使多年后，我们也几乎未发现舟骨与桡骨之间出现关节病。根据这些结果，我们推荐米特尔迈尔提出的方法用于治疗月骨无菌性坏死，即使是月骨出现碎裂和塌陷的严重病例。
