Bochud R C, Büchler U
Division of Hand Surgery, University of Bern, Inselspital, Switzerland.
J Hand Surg Br. 1994 Aug;19(4):466-78. doi: 10.1016/0266-7681(94)90212-7.
Early stage 3 Kienböck's disease has been treated by inner débridement, recontouring, height reconstruction, bone grafting and core revascularization of the lunate; additional procedures included temporary external fixation of the wrist and/or shortening osteotomy of the radius in selected cases. 26 patients, representing an uninterrupted series of 28 procedures, were followed-up for an average of 6.7 years (range 2.5-9.3 years) with periodic clinical and radiographic evaluations until they reached the final comprehensive assessment that included trispiral tomography and MRI. Every patient was subjectively improved, pleased with the result and able to resume his previous job. Pain intensity, rated on a zero to five scale, improved from 2.5 points pre-operatively to a final score of 0.8 points. Wrist motion gained slightly. Grip strength improved significantly. Lunate reconstruction proved successful in 37% of the cases; in an additional 23%, the disease process was stabilized. Carpal height decreased 4.7%; ulnar translation was not substantially altered. Arthrosis increased postoperatively in 55%, remained unchanged in 36% and progressed in 9%. Overall, 43% good and excellent, 43% fair and 14% poor results were observed.
早期3期月骨无菌性坏死采用月骨内部清创、重塑轮廓、高度重建、植骨及核心血管再生进行治疗；在部分病例中，额外的手术包括腕关节临时外固定和/或桡骨缩短截骨术。26例患者共接受了28次连续手术，平均随访6.7年（范围2.5 - 9.3年），定期进行临床和影像学评估，直至完成包括三层螺旋CT和MRI在内的最终综合评估。每位患者主观上均有改善，对结果满意，并能够恢复之前的工作。疼痛强度按0至5分进行评分，术前为2.5分，最终评分为0.8分。腕关节活动度略有增加。握力显著改善。37%的病例月骨重建成功；另外23%的病例病情得到稳定。腕骨高度降低了4.7%；尺侧移位无明显改变。55%的患者术后关节病加重，36%无变化，9%病情进展。总体而言，观察到43%的结果为优，43%为良，14%为差。
