掌长肌腱填塞和STTC融合治疗月骨无菌性坏死的疗效

Palmaris longus tendon plugging and STTC arthrodesis for treatment of Kienbock's disease

目的 报道月骨摘除后用掌长肌腱球填塞和腕舟骨 ,大、小多角骨 ,头状骨融合固定术(STTC) ,治疗月骨缺血性坏死的结果。方法 对 17例患者行坏死月骨摘除术后填塞掌长肌腱球 ,同时行舟骨 -大、小多角骨 ,舟 -头关节融合术。结果 术后随访 14～ 5 8个月 ,平均 2 3.6个月。 9例腕痛完全缓解 ,7例仍有轻度疼痛 ,1例腕痛严重。腕背伸平均度数为术前的 95 %、正常侧的 46 .4% ;掌屈平均度数为术前的 6 5 .4%、正常侧的 5 6 %。握力平均达正常侧的 75 %。 17例中 16例的舟、大、小多角骨、头状骨均已完全融合 ,腕高指数平均为 0 .49。结论 应用该法治疗 、 期的月骨缺血性坏死 ,能有效地缓解疼痛。

Objective To report the results of treating Kienbock's disease by means of palmaris longus tendon plugging and STTC arhthrodesis. Methods 17 patients with Kienbock's disease were involved in this study. The necrosed lunate was excised with simutaneous palmaris longus tendon plugging and scaphoid trapezium trapezoid, scaphoid capitate arthrodesis. Results All patients were followed up for 14 ～ 58 months, with an average of 23.6 months. Relief of pain was obtained in mine cases. Seven patients experienced mild pain and one still requires daily analgexics to relieve the pain. Extension of the wrist was on average 46.4 % of the normal side and 95 % of the preoperative range of motion. Flexion was on average 56 % of the normal side and 65.4 % of the preoperative range of motion. The grip strength was 75 % of the normal side. Bony union of the STTC was observed in 16 cases. Stahl index was on average 0.49. Conclusions Palmaris longus tendon plugging and STTC fusion following lunate excision is an effective method to treat Kienbock's disease of stage Ⅲand Ⅳ.