目的:患有Kienbock病的患者可表现为冠状骨折和月骨近端塌陷(统一B2/Bain1级,2B级)。传统上,这被认为是无法挽救的。然而,股骨内侧滑车(MFT)骨软骨重建,用来重建月近表面,可以与冠状平面骨折的复位和修复配对,从而恢复了腕骨中部。这项研究的目的是报告MFT骨软骨重建时的月冠状骨折固定后的影像学和临床结果。
方法:这是一项在单一机构进行的回顾性研究。我们确定了2014年至2023年接受MFT骨软骨重建的Kienbock病患者。如果患者在手术时固定了月球远端关节面的冠状骨折,则将其包括在内。评估影像学和临床参数,包括腕骨高度比,联合汇率,异位骨化的存在,需要翻修手术,和患者报告的结果指标。
结果:包括33例患者,平均年龄27.5岁(范围:15-41);19(58%)是女性。平均影像学随访时间为5.8个月,平均临床随访时间为22.6个月。在30/33例患者中实现了联合(91%)。腕骨高度比从1.32提高到1.4。两名患者(6%)需要再次手术,一种用于去除异位骨化,另一种用于转换为近排腕骨切除术。患者在简短的密歇根手问卷和患者报告的结果测量信息上肢评分中表现出有意义的改善。手术前后的活动范围相似。
结论:MFT骨软骨重建的Lunate冠状骨折固定术代表了Kienbock病患者的另一种治疗选择。该技术可在月肉重建期间恢复腕中关节,并可使患者避免抢救程序。早期影像学和临床结果是有希望的。
方法:治疗IV。
OBJECTIVE: Patients with Kienbock disease can present with coronal fracture and collapse of the proximal lunate (Unified B2/Bain grade 1, 2B). Traditionally, this was considered unsalvageable. However, medial femoral trochlea (MFT) osteochondral reconstruction, used to recreate the proximal lunate surface, can be paired with reduction and repair of the coronal plane fracture, thus restoring midcarpal congruity. The purpose of this study was to report radiographic and clinical outcomes following lunate coronal fracture fixation at the time of MFT osteochondral reconstruction.
METHODS: This was a retrospective study performed at a single institution. We identified patients with Kienbock disease who underwent MFT osteochondral reconstruction from 2014 to 2023. Patients were included if they had a coronal fracture of the lunate distal articular surface fixed at the time of surgery. Radiographic and clinical parameters were evaluated, including carpal height ratio, union rate, presence of heterotopic ossification, need for revision surgery, and patient-reported outcome measures.
RESULTS: Thirty-three patients were included, with a mean age of 27.5 years (range: 15-41); 19 (58%) were women. Mean radiographic follow-up time was 5.8 months, and mean clinical follow-up time was 22.6 months. Union was achieved in 30/33 patients (91%). Carpal height ratio improved from 1.32 to 1.4. Two patients (6%) required reoperation, one for removal of heterotopic ossification and another for conversion to proximal row carpectomy. Patients demonstrated meaningful improvement in brief Michigan Hand Questionnaire and Patient-Reported Outcomes Measurement Information Upper Extremity scores. Range of motion before and after surgery was similar.
CONCLUSIONS: Lunate coronal fracture fixation with MFT osteochondral reconstruction represents an additional management option in select patients with Kienbock disease. This technique restores the midcarpal joint during lunate reconstruction and may allow patients to avoid salvage procedures. Early radiographic and clinical outcomes are promising.
METHODS: Therapeutic IV.