PDF(Pubmed)
Abstract：
Kienböck\'s disease is best understood as a continuous interaction between compromised perfusion and structural deterioration that transitions from an early phase to a late phase. Existing literature has failed to identify any one superior treatment for Kienböck\'s; many studies even demonstrate no advantage for surgery compared with the natural history. Surgical interventions for early and transitional Kienböck\'s are designed to preserve or reconstruct the lunate. However, in most studies, the only tool used to assess the lunate itself has been plain radiography that neither reveals critical architectural details (demonstrated by computed tomographic scan) nor the vascular status (demonstrated by magnetic resonance imaging). Most articles, therefore, do not adequately define the preoperative status of the lunate or its alteration through surgical intervention. Critical preoperative features that are best demonstrated by these advanced imaging studies have specific anatomic and physiologic relationships that better correspond with certain surgical interventions, which also pair better with specific patient characteristics. This review explains how to identify, analyze, and strategically match these variables with the treatment interventions available for Kienböck\'s patients through the early, transitional, and late phases of the disease.
摘要：
Kienböck病最好理解为灌注受损和结构恶化之间的持续相互作用，从早期阶段过渡到晚期阶段。现有文献未能确定任何一种优于Kienböck的治疗方法；许多研究甚至证明与自然史相比，手术没有优势。早期和过渡性Kienböck的手术干预旨在保存或重建月体。然而,在大多数研究中,用于评估月体本身的唯一工具是平面X线摄影术,它既不显示关键的结构细节(通过计算机断层扫描显示),也不显示血管状态(通过磁共振成像显示).大多数文章,因此,不要通过手术干预充分定义月的术前状态或其改变。这些先进的影像学研究最好地证明了关键的术前特征具有特定的解剖和生理关系，与某些手术干预措施更好地对应。这也与特定的患者特征更好地配对。这篇评论解释了如何识别，分析,并战略性地将这些变量与Kienböck患者早期可用的治疗干预措施相匹配，过渡,和疾病的晚期阶段。
