■改变手腕生物力学,Kienbock病导致进行性腕骨塌陷,导致早期关节炎和退行性变化。通过将加载轴移向辐射状关节,据报道,肩关节固定术(SCA)是一种有效治疗有症状的晚期Kienbock病患者的抢救方法。在这项研究中,我们旨在评估有症状的晚期Kienbock病患者关节镜下SCA的临床和放射学结果.
■在2010年3月至2021年2月期间,我们纳入了15例有症状的IIIA期(n=2)和IIIB期(n=13)的Kienbock病患者,他们在关节镜下SCA伴或不伴月切除术后至少24个月的随访。6例患者切除了月牙,9例保留了月牙。视觉模拟量表(VAS)疼痛评分,握力,运动范围(ROM),主动屈伸弧,术前和术后每次随访时测量改良的Mayo腕关节评分(MMWS)。还评估了与手术相关的并发症和影像学变化。
■有13名女性和2名男性,平均年龄57.6岁(范围,21-74岁)在接受关节镜SCA时。随访时间为24至116个月,平均56.9±32.3个月。所有患者都实现了Bony联盟。在术前检查时,手腕ROM(67%)和握力(48%)显著下降,与对侧手腕相比。在最后的后续行动中,VAS有显著改进,握力,和MMWS,而活跃的手腕ROM没有显着变化。手术后,放射性舟角恢复,而放射学腕骨塌陷和腕骨的尺骨平移发生。在根据月肉切除的亚组分析中,VAS没有显着差异,MMWS,握力,或总ROM。然而,在月骨切除组中,尺骨平移增加,径向偏离减少。
■关节镜SCA在晚期Kienbock\'s病患者的疼痛和腕关节功能方面取得了显着改善,而没有任何并发症。进行关节镜SCA时切除月骨似乎会引起进行性腕尺平移,与保留它相比没有明显的临床益处。
UNASSIGNED: Altering wrist biomechanics, Kienbock\'s disease leads to progressive carpal collapse that results in early arthritis and degenerative changes. By shifting the loading axis toward the radioscaphoid joint, scaphocapitate arthrodesis (SCA) has been reported as a salvage procedure effective in treating symptomatic patients with advanced Kienbock\'s disease. In this study, we aimed to evaluate the clinical and radiological outcomes of arthroscopic SCA in symptomatic patients with advanced stages of Kienbock\'s disease.
UNASSIGNED: Between March 2010 and February 2021, we included 15 patients with symptomatic stage IIIA (n=2) and stage IIIB (n=13) Kienbock\'s disease who were followed up for a minimum of 24 months after arthroscopic SCA with or without lunate excision. The lunate was excised in 6 patients and retained in 9. Visual analog scale (VAS) pain score, grip strength, range of motion (ROM), active flexion-extension arc, and modified Mayo wrist score (MMWS) were measured preoperatively and at each follow-up examination after surgery. Operation-related complications and radiographic changes were also assessed.
UNASSIGNED: There were 13 women and 2 men, with a mean age of 57.6 years (range, 21-74 years) at the time of undergoing arthroscopic SCA. Follow-up ranged from 24 to 116 months, with an average of 56.9 ± 32.3 months. Bony union was achieved in all patients. At preoperative examination, wrist ROM (67%) and grip strength (48%) significantly decreased, compared to the contralateral wrist. At the final follow-up, there were significant improvements in VAS, grip strength, and MMWS, whereas the active wrist ROM showed no significant change. Radioscaphoid angle recovered after surgery, while radiographic carpal collapse and ulnar translation of the carpus occurred. In subgroup analysis according to excision of the lunate, there were no significant differences in VAS, MMWS, grip strength, or total ROM. However, increased ulnar translation and decreased radial deviation were noted in the lunate excision group.
UNASSIGNED: Arthroscopic SCA achieved significant improvements in pain and wrist function in patients with advanced Kienbock\'s disease without any complications. Excision of the lunate when performing arthroscopic SCA seemed to induce progressive carpal ulnar translation, with no apparent clinical benefits over retaining it.