带蒂豌豆骨移位治疗月骨无菌性坏死

Transplantation of pedicled pisiform bone to replace lunate bone with aseptic mecrosis

目的 探讨治疗月骨无菌性坏死新的有效方法。方法在２５例成人上肢标本和５７套腕骨标本上观察了碗豆骨的形态和血供。在解剖学研究的基础上，采用带血管蒂和尺侧腕屈肌腱的豌豆骨移位替代月骨，治疗月骨无菌性坏死１７例。结果经１８～４６个月，平均２８个月的随访，１７例腕痛全部缓解，腕关节活动度较术前改善，握力比术前增加４８．２％。Ｘ线片见：１６例带蒂豌豆骨移位骨位置正常，无骨硬化和骨萎缩，１例术后２年豌豆骨萎缩。１７例患者中１５例恢复原工作，２例因社会原因改换工作。结论带蒂豌豆骨移位能有效地保持腕骨链的完整，是治疗月骨无菌性坏死Ⅲ期的一种有效手术方法。

Objective To find out a new and effective methed for the treatment of aseptic necrosis of lunate bone, Methods Blood supply and morphology of pisiform bone were investigated in 25 upper limbs and 57 sets of carpal bone from adult cadavers on the basis of anatomical study, The lunate bone was re- placed with pisiform bone of pedicled blood vessel and tendon of musculus flexor earpiulnaris in 17 pa- tients with aseptic necrosis of lunate bone (stage Ⅲ ) . Results The patients were followed up for 18～ 46 months (average of 28 months). Complete relief of pain was obtained in all of the patients , and the range of motion of their wrists was improved. Grip strength was increased by 46. 2% , Radiograph showed normal location of transferred pisiform bone without osteosclerosis and atrophy in 16 patients. Atraphy of pisiform bone was found 2 years after operation in one patient. In the 17 patients , 15 re- sumed their original jobs and 2 changed their jobs for other reasons Conclusion We consider that the carpal bone chain can be completely preaesrved by transpltntation of pedicled pisiform bone , which it is an effective method to treat aseptic necrosis stage Ⅲ of lunate bone