关节镜辅助下的舟骨-大小多角骨融合术治疗月骨缺血性坏死  

Arthroscopic-assisted scapho-trapezio-trapezoeid arthrodesis for the treatment of Kienböck disease

作　　者：雷高炜 冯俊涛 尹华伟 沈云东 徐文东 Lei Gaowei;Feng Juntao;Yin Huawei;Shen Yundong;Xu Wendong(Department of Hand Surgery,Huashan Hospital Affiliated to Fudan University,Key Laboratory of Hand Reconstruction of Health Ministry,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院手外科,卫生部手功能重建重点实验室,上海市周围神经显微外科重点实验室,上海200040

出　　处：《中华手外科杂志》2020年第4期279-282,共4页Chinese Journal of Hand Surgery

基　　金：国家自然科学基金(81873766)。

摘　　要：目的探讨关节镜辅助下腕部舟骨-大小多角骨关节(scapho-trapezio-trapezoeid,STT)融合术治疗晚期月骨缺血性坏死的临床疗效。方法自2013年2月至2016年3月我们对11例LichtmanⅢb期月骨缺血性坏死患者,采用关节镜辅助下STT融合术治疗。所有患者术前、术后均测定腕关节运动范围和握力,并进行腕关节PRWE和改良Mayo腕关节评分。根据术前及术后腕部X线片情况进行疗效评估。结果术后11例患者均获得随访,时间为13~91个月,平均40.8个月。术前VAS疼痛评分平均(6.45±0.58)分,术后(1.90±0.37)分,比较差异有统计学意义(P<0.05),术后腕关节疼痛均得到缓解。术前患侧握力平均为(8.53±1.83)kg,术后(14.48±2.38)kg;腕关节PRWE评分术前为74.86±2.13,术后21.46±4.57;改良Mayo腕关节评分术前为31.36±2.53,术后70.91±3.22,差异均有统计学意义(P<0.05),术后腕关节握力及功能评分均明显改善。远期X线片结果表明患者月骨塌陷于术后无明显加剧。结论关节镜辅助下的STT融合术治疗LichtmanⅢb期月骨缺血性坏死,可以良好地缓解疼痛,改善腕关节功能,防止月骨继续塌陷、疾病进展,而对于腕关节主动活动度无明显改善。Objective To investigate the clinical efficacy of arthroscopic-assisted scapho-trapezio-trapezoeid(STT)arthrodesis for the treatment of the LichtmanⅢb stage Kienböck disease.Methods From February 2013 to March 2016,11 patients diagnosed as LichtmanⅢb stage Kienböck disease were treated by arthroscopic-assisted STT arthrodesis.The range of motion and grip strength of the wrist were measured before and after the operation,and the wrist PRWE and the modified Mayo wrist score were performed.The curative effect was evaluated according to the X-ray examination results before and after operation.Results All the 11 patients were follow-up for 13 to 91 months,with an average of 40.8 months.The average score of VAS was(6.45±0.58)before operation and(1.90±0.37)after operation.The difference was statistically significant(P<0.05).The wrist pain was relieved after operation.The average grip strength before operation was(8.53±1.83)kg,and after operation was(14.48±2.38)kg;the wrist PRWE score before operation was 74.86±2.13,and after operation was 21.46±4.57;the modified Mayo wrist score before operation was 31.36±2.53,and after operation was 70.91±3.22.The differences were statistically significant(P<0.05),and the wrist grip strength and function score after operation were significantly improved.The results of long-term X-ray showed that there was no obvious aggravation after the operation.Conclusion The application of arthroscopic-assisted STT arthrodesis for the treatment of LichtmanⅢb stage Kienböck disease can relieve the pain,improve the function of wrist joint,prevent the collapse of the lunate and the progression of the disease,but not improve the active motion of wrist joint.

关 键 词：月骨 骨坏死 关节融合术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]