骨水泥假体置换治疗月骨缺血性坏死的临床研究  

Treatment of Kienbock's disease with bone cement prosthesis

作　　者：李睿夫[1] 缪旭东[1] 闫乔生[1] 许有[1] 贾晶[1] 刘海龙[1] 

机构地区：[1]中国人民解放军第五医院骨科三病区,宁夏银川750000

出　　处：《中国现代医学杂志》2017年第1期107-110,共4页China Journal of Modern Medicine

摘　　要：目的研究骨水泥假体治疗晚期月骨坏死的可行性和疗效。方法选取2004年1月-2015年12月该院采用骨水泥假体置换治疗晚期月骨坏死的患者10例。术中通过摘除坏死月骨,用骨水泥制作并适应性加工骨水泥月骨假体进行置换。术后随访≥1年,通过测量患者患侧手术前后及健侧手的疼痛程度、碗关节屈伸角度、握力、腕骨高度比、桡舟角及远期退变症状来评价疗效。结果所有患者术后切口皆Ⅰ期愈合,无并发症发生。术后随访1年,疗效评估以1年后复诊结果为准。末次随访时,患者视觉模拟评分为(2.0±1.15)分,较术前改善(P<0.05)。腕关节屈伸角度(103±7.79)°,较术前改善(P<0.05),但对比健侧仍受限。术后握力(36.8±5.96)kg,相对术前改善(P<0.05),但仍较健侧低,约为健侧的(85±13)%。术后腕高比值(0.54±0.02),手术前后,术后与健侧对比,差异无有统计学意义(P>0.05)。患者再无进一步的月骨塌陷和腕骨重排。术后桡舟角(58.8±6.91)°,较术前改善(P<0.05)。结论骨水泥假体治疗月骨坏死能够有效终止腕骨塌陷,缓解疼痛症状,改善手部功能并停止病情进展,同时在易用性、安全性和经济上具有一定的优势。Objective To study the outcome and feasibility of substitution of lunate with bone cement prosthesis in Liehtman III B-IV patients. Methods Ten patients were treated by lunate substitution with bone cement prosthesis between January 2004 and December 2015. The necrotic lunate was removed and replaced with bone cement in the operation. The visual analogue scale, wrist flexion angle, grip strength, carpal height ratio, radioscaphoid angle and osteoarthritic condition were measured to evaluate the result after 1-year follow-up. Results All the patients got primary healing after surgery, no subsidiary injury occurred. In the final follow up, the VAS was （2.00 ± 1.15）, which was significantly improved compared with that before operation （P〈0.05）. The wrist flexion angle was improved to （103 ± 7.79）°, which was much better than that before operation but still smaller than that of the normal side. Grip strength was increased to （36.80± 5.96） kg, the improvement had statistical significance, but was only （85 ± 13）% of strength of the normal side. The carpal height ratio was （0.54 ± 0.02） without significant difference compared with preoperative value （P〉 0.05）. There was no further collapse of carpal. The radioscaphoid angle was （58.80 ± 6.91）°, the improvement had statistical significance compared with that before operation （P 〈 0.05）. Conclusions The lunate substitution by bone cement prosthesis can stop the collapse of carpal, relieve the pain and improve the function of hand and wrist. Bone cement prosthesis is more convenient, safer and more economic compared with other traditional prostheses.

关 键 词：月骨缺血性坏死 骨水泥假体置换 疗效 

分 类 号：R681.7[医药卫生—骨科学]