桡骨楔状切骨术治疗月骨无菌性坏死的疗效观察

Clinical Efficacy of Kienbock's Disease by Radial Wedge Osteotomy

目的 :我们对进行期或中高年者的月骨无菌性坏死选择包裹骨核的筋膜球置换术 ,对进行期或青状年者采取桡骨切骨术进行治疗。这次将桡骨切骨术后的经过作了调查 ,报告如下。方法 :自 1994年以来 ,使用本法的 8例患者 ,手术时年龄 2 0～ 38岁 (平均 2 6岁 )。术前的Lichtman分类 ,ⅢA、ⅢB各 4例。全例未见尺骨负变 ,施行了桡骨楔状切骨 ( 15°)和短缩约 1mm。术后时间 7个月～ 3年零 2个月 ,平均 1年零 5个月。结果 :术前安静时痛 3例 ,运动时痛 7例 ,调查时安静痛全例消失 ,1例残留运动痛。腕关节掌背屈活动度从平均 83°增至 98°。握力健侧比自平均 5 8%增至79% ,显著改善了。X线片上所测的CHR、Stahl′sindex ,术前和调查时未发生变化 ,病期尚未发展。根据Nakamura氏的判定标准 ,优 2例 ,良 4例 ,可 2例。 8例中全例都已工作。结论 :对月骨无菌性坏死选择病例的话 ,桡骨楔状切骨术在X线片上病期未发现进行性发展 ,而且临床成绩良好。

Objective:In the treatment of Kienbock's disease in the progressive stage and in middle and advanced-age patients,we selected r eplacement arthroplasty using a bone cored fascial ball,while in Kienbock's disease in the early stage and in young patients we employed radial wedge osteot omy.Methods:Since 1994,radial wedge osteotomy was performed on 8 patients,aged 2 0 to 38 years (average 26 years).Lichtman classification prior to operation was ⅢA in 4 cases and ⅢB in the other 4.Ulnar variance was zero in all patients,an d radial wedge osteotomy of 15° and shortening of approximately 1mm were conduc ted.The postoperative follow-up period ranged from 7 months to 3 years and 2 mo n ths (average 1 year and 5 months).Results:Preoperatively,3 patients had pain at rest and 7 had pain in movement,but at the time of follow-up,pain at rest had d i sappeared in 3,and pain in movement remained in only 1 patient.Range of motion o f palmar and dorsal flexion of the hand joint increased from 83 to 98°,however, the increase was not significant.Grip,in comparison with the contralateral side, showed a significant average increase from 58 to 79%.Radiologically,carpal heigh t ratio and Stahl's index showed no change at follow-up when compared to the pr eoperative findings.No evidence of progression could be observed.According to Na kamura's evaluation criterion,the results were excellent in 2 cases,good in 4,an d fair in 2.All 8 patients are now engaged in work.Conclusions:For Kienbock's di sease,this study proved that through radial wedge osteotomy in selected cases th ere was radiologically no progression in disease stage,and the clinical results were good.