腕舟头骨局限性融合治疗Ⅲ期月骨无菌性坏死的长期随访研究  

Scaphocapitate arthrodesis for Lichtnmn stage m KienbOck＇s disease： a long-term follow-up study

作　　者：邓爱东[1] 顾剑辉[1] 陈情忠[1] 

机构地区：[1]南通大学附属医院手外科、手外科研究所,江苏226001

出　　处：《中华手外科杂志》2014年第3期180-184,共5页Chinese Journal of Hand Surgery

摘　　要：目的通过对腕舟头骨局限性融合治疗Ⅲ期月骨无菌性坏死进行长期随访研究，评价其远期疗效。方法2003年10月至2006年11月对8例Ⅲ期月骨无菌性坏死患者采用腕舟头局限性腕骨融合进行治疗，术后平均随访时间为85．3个月（66，118个月）。所有患者术前、术后均进行腕关节运动范围和握力测定，并进行Gartland—Werley腕关节功能评定及DASH评分。结果术后所有患者腕痛完全缓解，均能够胜任原工作。腕关节活动范围：术前背伸51．3°±15．3°，术后背伸45．5°±15．7°；术前掌屈43．1°±5．3°，术后掌屈34．0°±10．0°；术前旋前75．6°±8．6°，术后旋前76．9°±10．0°；术前旋后76．3°4±10．3°，术后旋后79．4°±11．2°；术前尺偏17．5°±2．7°，术后尺偏17．6°±3．5°；术前桡偏13．1°±7．5°，术后桡偏11．9°±8．0°。统计表明手术前后腕关节运动范围没有明显降低。术前握力为（8．1±6．9）kg，术后握力为（31．3±7．3）kg；Gartland—Werley腕关节评分术前为13．1±2．4，术后为5．6±3．8；DASH评分术前为21．8±3．0，术后为8．6±5．5，统计表明握力、腕关节评分及DASH评分均得到显著改善。X线检查腕高比没有明显的降低，无一例患者发生腕关节退变性关节炎。结论应用舟头局限性腕骨融合术治疗Ⅲ期月骨无菌性坏死能够有效缓解腕关节疼痛，提高握力，但是腕关节活动范围并无改善。Objective To evaluate the long term results of scaphocapitate arthrodesis for the treatment of Lichtman stage Ⅲ Kienboeck＇ s disease. Methods Between October 2003 and November 2006, 8 cases of stage Ⅲ Kienboek＇s disease were treated with scaphocapitate arthrodesis. Postoperative follow-up was an average of 85.3 months （range, 66 to 118 months）. Clinical evaluation included preoperative and postoperative range of motion, grip strength, Disabilities of the Arm, Shoulder and Hand （DASH） scores and Gartland-Werley wrist scores. Radiographic evaluation included carpal height ratio and signs of wrist joint degenerative arthritis. Results All the patients reported an improvement in their symptoms and were pain free after the operation. They were able to return to their work. Wrist range of motion was 51.3° ±15.3°preop vs 45.5°± 15.7°postop for extension, 43.1° ± 5.3°preop vs 34.0° ± 10.0°postop for flexion, 75.6°±8.6°preop vs 76.9° ± 10.0°postop for pronation,76.3°± 10.3°preop vs 79.4° ± 11.2°postop for supination, 17.5° ± 2.7°preop vs 17.6° ± 3.5° postop for unlar deviation, and 13.1° ±7.5°preop vs 11.9°±8.0°postop for radial deviation. There was no significant differenee in the pre- and post-operative wrist motion. Grip strength was （8.1 ± 6.9） kg preoperatively and （31.3 ± 7.3 ） kg postoperatively. Gartland-Werley scores changed from 13.1 ± 2.4 to 5.6± 3.8, while DASH scores from 21.8 ±3.0 to 8.6 ±5.5. Improvements in grip strength, Gartland-Werley scores and DASH scores were all statistically significant. Radiographicafly there was no significant change in carpal height ratio and no joint degenerative arthritis. Conclusion For stage Ⅲ Kienb6ck＇s disease scaphocapitate arthrodesis can alleviate wrist pain, improve grip strength and DASH and Gartland-Werley scores. It however does not improve wrist range of motion.

关 键 词：月骨 骨坏死 关节固定术 功能评价 

分 类 号：R687.3[医药卫生—骨科学]