腕骨间融合联合带蒂豌豆骨移位治疗月骨缺血性坏死

Intercarpal fusion combining transfer of pedicled pisiform bone for Kienbck disease

对采用腕骨间融合联合带蒂豌豆骨移位治疗月骨缺血性坏死的疗效作一评估。用此法治疗月骨缺血性坏死（Ⅲ期，Ｌｉｃｈｔｍａｎ）８例．月骨切除后用带血管蒂豌豆骨移位替代月骨；腕骨间融合采用舟骨、大多角骨、小多角骨融合５例，舟骨、头状骨融合３例。随访８～４４个月，平均２９个月。８例腕痛全部缓解，腕关节活动比术前改善：背伸达正常侧的５８．８％，屈曲达５１．４％。握力比术前增加４６．９％。Ｘ线片结果：带蒂豌豆骨移位骨位置正常，无骨硬化；１例术后２年发现豌豆骨萎缩。８例病人中有６例恢复原工作，２例因社会原因改换工作。我们认为腕骨间融合联合带蒂豌豆骨移位是治疗月骨缺血性坏死Ⅲ期的一种有效方法．

We used intercarpal fusion combining transfer of pedicled pisiform bone clinically evaluate its effectiveness in treating Kienbock disease. Eight cases of Kienbock disease (stage III) were treated with thismethod. The lunate bone was removed and was replaced with pedicled pisiform bone. Intercarpal fusion included scaphoid, trapezium and trapizoid bones fusion in 5 cases and scaphoid, capitate bone fusion in3 cases. The patients were followed up for 8-44 months with an average of 29 months. Complete reliefof pain was obtained in all the patients. The ranges of motion of the wrist were improved: the extensionand flexion averaged 58. 8% and 51. 4% of the normal side, respectively. The grip strength was increased by 46. 9%. Radiograph showed normal location of transferred pisiform bone without osteosclerosis. Atrophy of pisiform bone was found 2 years postoperatively in one case. The intercarpal fusionwas stable. Six of the eight patients returned to their original job. We conclude the technique of intercarpal fusion combining transfer of pedicled pisiform bone is an effective method to treat ischemic necrosis stage III of lunate bone'