腕月骨无菌性坏死的诊断、分类和治疗  

Diagnosis, classification and treatment of Kienbck's disease

作　　者：路来金[1,2,3] 王江宁[1,2,3] 张志新[1,2,3] 刘志刚 张冠军[1,2,3] 

机构地区：[1]白求恩医科大学第一临床病院手外科 [2]大连市中心医院手外科 [3]山西阳泉市固庄煤矿医院

出　　处：《中华手外科杂志》1998年第1期35-37,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨月骨无菌性坏死的临床诊断特点和分类，规范筛选确切的治疗方法。方法对近１２年间收治的５１例腕月骨无菌性坏死进行总结和分析。结果腕月骨无菌性坏死的早期症状不典型，腕部Ｘ线平片是诊断和分类的基础，ＭＲＩ和同位素扫描有确切的临床应用价值。临床分类以Ｌｉｃｈｔｍａｎ的４期分类法最为适用。Ⅰ期１例，经保守治疗后基本恢复正常；Ⅰ～Ⅳ期５０例，共采用８种手术方法进行治疗，结果均达到临床治愈。对已发生塌陷碎裂的月骨，任何方法均不能恢复其正常的形状。结论可应用Ｘ线片、ＭＲＩ、同位素扫描等进行早期诊断。手术治疗对Ⅰ、Ⅱ期病例宜选用月骨血运重建和生物力学方法；对Ⅲ、Ⅳ期患者选用头状骨移位替代术较合适；对合并舟、三角骨吸收或轻度创伤性关节炎者首选近排腕骨切除术。Objective To discuss the clinical characteristics and classification of lunate avascular necrosis and the selection of treatment procedures. Methods 51 cases of Kienbck's disease treated in the past 12 years were reviewed and analyzed. Results There were no typical clinical symptoms of Kienbck's disease in the early stage. Routine roentgenography of the wrist provided evidence to the diagnosis and classification of it. Magnetic resonant image and isotopic scanning were also useful to some extent. Lichtman's four stage classification was most suitable for classification in clinical practice. One case which was rated stage I was cured by conservative treatment. There were 50 cases rated from stage II to stage IV, which were treated by eight surgical procedures. Clinical cure was achieved in all these cases. As for the cases in which collapse of the lunate bone already happened, no method was effective to restore its normal bony contour. Conclusions Routine roentgenography, magnetic resonant image and isotopic scanning were useful for early diagnosis of Kienbck's disease.For cases rated stage I～II, revascularization of the lunate and biomechanical correction were surgical procedures of choice. Capitate transposition was suitable for stage III and stage IV cases. When there was absorption of scaphoid and lunate bones and mild traumatic arthritis, proximal carpectomy was the first choice.

关 键 词：月骨 骨坏死 无菌性骨坏死 诊断 分类法 治疗 

分 类 号：R681.7[医药卫生—骨科学]