PDF(Pubmed)
Abstract：
BACKGROUND: There are several surgical options for osteonecrosis of the lunate, and confirming the effectiveness of various surgical methods remains challenging. Here, we present a case of stage IIIB osteonecrosis of the lunate repaired with a free medial femoral condyle osteocutaneous flap.
METHODS: A 43-year-old male construction worker was admitted to our hospital due to right wrist pain, impaired mobility, and pain aggravated by activity for 10 months. The patient was diagnosed with stage IIIB osteonecrosis of the lunate based on the orthopantomogram and magnetic resonance imaging of the right wrist. Considering the patient\'s medical history, physical examination, auxiliary examination, and wishes, reconstruction was performed using a free medial femoral condyle osteocutaneous flap. After the flap survived completely, the K-wires were removed one month after the operation, the external brace was removed two months after the operation, and functional wrist rehabilitation was initiated. After six months of follow-up, the wrist swelling and pain resolved, and the reconstructed lunate bone was viable. Additionally, the last follow-up was conducted in the sixth month after surgery; the affected hand grip strength improved from about 70% (28 kg) to 80% (32 kg) compared with the healthy side (40 kg); the visual analog scale score decreased from 6.5 points before the operation to 1 point; and the MAYO score increased from 60 points before the operation to 85 points.
CONCLUSIONS: The success of this case reinforces the potential of the free medial femoral condyle osteocutaneous flap as a new treatment option for stage IIIB osteonecrosis of the lunate and further expands the existing treatment options. Using a free medial femoral condyle osteocutaneous flap to reconstruct the lunate and restore the carpal anatomy may.
METHODS: A 43-year-old male construction worker was admitted to our hospital due to right wrist pain, impaired mobility, and pain aggravated by activity for 10 months. The patient was diagnosed with stage IIIB osteonecrosis of the lunate based on the orthopantomogram and magnetic resonance imaging of the right wrist. Considering the patient\'s medical history, physical examination, auxiliary examination, and wishes, reconstruction was performed using a free medial femoral condyle osteocutaneous flap. After the flap survived completely, the K-wires were removed one month after the operation, the external brace was removed two months after the operation, and functional wrist rehabilitation was initiated. After six months of follow-up, the wrist swelling and pain resolved, and the reconstructed lunate bone was viable. Additionally, the last follow-up was conducted in the sixth month after surgery; the affected hand grip strength improved from about 70% (28 kg) to 80% (32 kg) compared with the healthy side (40 kg); the visual analog scale score decreased from 6.5 points before the operation to 1 point; and the MAYO score increased from 60 points before the operation to 85 points.
CONCLUSIONS: The success of this case reinforces the potential of the free medial femoral condyle osteocutaneous flap as a new treatment option for stage IIIB osteonecrosis of the lunate and further expands the existing treatment options. Using a free medial femoral condyle osteocutaneous flap to reconstruct the lunate and restore the carpal anatomy may.
摘要：
背景：对于月骨坏死有几种手术选择，确认各种手术方法的有效性仍然具有挑战性。这里,我们介绍了一例使用游离的股骨内侧髁骨皮瓣修复的月骨IIIB期骨坏死。
方法：一名43岁男建筑工人因右腕部疼痛入院，行动不便，10个月的活动会加重疼痛。根据右手腕的正骨图和磁共振成像，该患者被诊断为月骨IIIB期骨坏死。考虑到病人的病史,体检,辅助检查,和愿望，使用游离的股骨内侧髁骨皮瓣进行重建。皮瓣完全存活后，手术后一个月拆除了K线，手术后两个月移除外部支架，并启动功能性腕关节康复。经过六个月的随访，手腕肿胀和疼痛缓解，重建的月骨是可行的。此外,末次随访于术后第6个月;受影响的手握力与健康方(40kg)相比,由约70%(28kg)提高至80%(32kg);视觉模拟量表评分由术前6.5分降低至1分;MAYO评分由术前60分提高至85分.
结论：该病例的成功加强了游离股骨内侧髁骨皮瓣作为IIIB期月骨坏死新的治疗选择的潜力，并进一步扩展了现有的治疗方案。使用自由的股骨内侧髁骨皮瓣重建月骨并恢复腕骨解剖可能。
方法：一名43岁男建筑工人因右腕部疼痛入院，行动不便，10个月的活动会加重疼痛。根据右手腕的正骨图和磁共振成像，该患者被诊断为月骨IIIB期骨坏死。考虑到病人的病史,体检,辅助检查,和愿望，使用游离的股骨内侧髁骨皮瓣进行重建。皮瓣完全存活后，手术后一个月拆除了K线，手术后两个月移除外部支架，并启动功能性腕关节康复。经过六个月的随访，手腕肿胀和疼痛缓解，重建的月骨是可行的。此外,末次随访于术后第6个月;受影响的手握力与健康方(40kg)相比,由约70%(28kg)提高至80%(32kg);视觉模拟量表评分由术前6.5分降低至1分;MAYO评分由术前60分提高至85分.
结论：该病例的成功加强了游离股骨内侧髁骨皮瓣作为IIIB期月骨坏死新的治疗选择的潜力，并进一步扩展了现有的治疗方案。使用自由的股骨内侧髁骨皮瓣重建月骨并恢复腕骨解剖可能。
