带血管蒂头状骨瓣移位治疗终末期月骨缺血性坏死的远期疗效

LONG-TERM EFFECTIVENESS OF VASCULARIZED CAPITATE OSTEOTOMY TRANSPOSITION FOR ADVANCED Kienbck's DISEASE

目的总结带血管蒂头状骨瓣移位治疗终末期月骨缺血性坏死的远期疗效。方法 2004年6月-2008年1月,采用带血管蒂头状骨瓣移位治疗16例LichtmanⅢB或Ⅳ期月骨缺血性坏死患者。男10例,女6例;年龄27～59岁,平均38.8岁。发病原因：创伤10例,原因不明6例。主要临床症状为腕关节疼痛伴活动受限;症状持续时间5～32个月,平均26.5个月。患侧腕高度指数为0.88±0.05,桡舟角为（63.8±9.1）°。结果术后切口均Ⅰ期愈合,无感染及神经、血管损伤等并发症发生。16例均获随访,随访时间5年4个月～9年,平均5.8年。末次随访时,腕关节VAS评分为（2.0±1.5）分。腕关节掌屈、背伸活动度均显著小于健侧（P0.05）;握力及腕关节功能Evans评分与健侧比较,差异均无统计学意义（t=—0.997,P=0.327;t=—1.852,P=0.077）。X线片测量示,患侧腕高度指数为0.94±0.03,桡舟角为（48.4±4.8）°,与术前比较差异均有统计学意义（t=—3.927,P=0.000;t=5.987,P=0.000）。6例出现桡骨背侧与头状骨背侧硬化带,2例出现舟骨旋转。结论采用带血管蒂头状骨瓣移位治疗终末期月骨缺血性坏死,尽管存在不同程度腕关节功能受限,但因腕关节疼痛消失及握力显著改善,远期疗效满意。

ObjectiveTo evaluate the long-term effectiveness of lunate excision and vascularized capitate osteotomy transposition for advanced Kienbǒck’s disease. MethodsBetween June 2004 and January 2008, 16 patients with Kienbǒck disease in Lichtman stages IIIB-IV were treated with lunate excision and vascularized capitate osteotomy transposition. There were 10 males and 6 females at the age of 27-59 years （mean, 38.8 years）. The disease was caused by trauma in 10 cases, and unknown reason in 6 cases. The main clinical symptoms were pain and limited activity of the wrist joint, and the disease duration was 5-32 months （mean, 26.5 months）. The carpal height index was 0.88 ± 0.05; the radioscaphoid angle was （63.8 ± 9.1）°. The visual analogue scale （VAS） score, range of motion （ROM）, grip strength, Evans score, and radiographic changes were used to assess the effectiveness during follow-up. ResultsAll patients obtained healing of incision by first intention and were followed up 5 years and 4 months to 9 years （mean, 5.8 years）. VAS score was 2.0 ± 1.5 at the final follow-up. The ROM of the flexion and extension of the wrist joint at the affected side were significantly less than those at the normal side （P 〈 0.05）. However, no significant difference was found in the grip strength and Evans score between the affected side and normal side （t= —0.997, P=0.327; t= —1.852, P=0.077）. Postoperative radiographs showed that the carpal height index was 0.94 ± 0.03, and the radioscaphoid angle was （48.4 ± 4.8）°, which were improved significantly when compared with preoperative ones （t= —3.927, P=0.000; t=5.987, P=0.000）. Osteophyte at the dorsal side of the radius and scaphoid rotation occurred in 6 cases and 2 cases, respectively. ConclusionLunate excision and vascularized capitate osteotomy transposition is a reliable method for advanced Kienbǒck’s disease, with favorable improvement in wrist pain and grip strength for long-term follow-up.