改良截骨的带血管蒂头状骨移位治疗月骨无菌性坏死  

Modified osteotomy with vascularized capitate bone transfer for the treatment of Kienbock′s disease

作　　者：唐举玉[1] 王玉玲 吴攀峰[1] 俞芳[1] 卿黎明[1] 庞晓阳[1] 潘丁[1] 肖勇兵[1] 曾磊[1] 刘睿[1] Tang Juyu;Wang Yuling;Wu Panfeng;Yu Fang;Qing Liming;Pang Xiaoyang;Pan Ding;Xiao Yongbing;Zeng Lei;Liu Rui(Department of Orthopedic and Hand Microsurgery,Xiangya Hospital of Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科手显微外科,长沙410008

出　　处：《中华手外科杂志》2022年第5期403-406,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨改良截骨的带血管蒂头状骨移位治疗月骨无菌性坏死的临床疗效。方法自2014年3月至2019年12月我科收治月骨无菌性坏死患者19例,其中Lichtman分期ⅢA期15例,ⅢB期4例。摘除坏死月骨后将头状骨斜形截骨,髂骨植骨修复头状骨继发骨缺损,带血管蒂头状骨移位重建月骨缺损。随访记录患侧握力、腕关节疼痛VAS评分、Quick-DASH评分、PRWE评分、腕骨高度指数及腕关节活动范围。结果本组术后随访16~86个月,平均47个月。切口均Ⅰ期愈合,无感染及神经血管损伤并发症。腕关节VAS疼痛评分术前为(5.53±1.46)分,术后为(2.12±1.41)分,术后疼痛较术前明显缓解。术前患侧腕关节平均握力为(10.05±2.83)kg,术后患侧腕关节平均握力为(28.45±4.58)kg;Quick-DASH评分术前为25.45±4.56,术后为8.12±1.81;PRWE术前评分为26.97±7.52,术后为4.41±1.73,差异均有统计学意义(P<0.05)。X线片显示腕关节高度指数术前为0.49±0.03,术后为0.48±0.04,差异没有统计学意义(P>0.05)。结论改良截骨的带血管蒂头状骨移位是一种治疗月骨无菌性坏死的有效方法。Objective To explore the clinical efficacy of modified osteotomy with vascularized capitate bone transfer for the treatment of Kienbock′s disease.Methods From March 2014 to December 2019,19 patients with Kienbock′s disease were treated in our department,including 15 cases of Lichtman stageⅢA and 4 cases ofⅢB.After the necrotic lunate bone was removed,the capitate bone was obliquely osteotomized,the iliac bone graft was used to repair the secondary bone defect of the capitate bone,and the vascularized capitate bone was transferred to reconstruct the lunate bone defect.The grip strength,wrist pain VAS,Quick-DASH score,PRWE score,wrist height index and wrist range of motion were recorded.Results The patients were follow-up for 16 to 86 months,with an average of 47 months.All the incisions achieved primary healing,and there were no complications of infection and neurovascular injury.The VAS of wrist joint was(5.53±1.46)points before operation and(2.12±1.41)points after operation.The postoperative pain was significantly relieved compared with that before operation.The average grip strength of the affected wrist was(10.05±2.83)kg before operation and(28.45±4.58)kg after operation.The Quick-DASH score was 25.45±4.56 before operation and 8.12±1.81 after operation.The PRWE score was 26.97±7.52 before operation and 4.41±1.73 after operation,with significant difference(P<0.05).X-ray film showed that the wrist height index was 0.49±0.03 before operation and 0.48±0.04 after operation,and the difference was not statistically significant(P>0.05).Conclusion The modified osteotomy with vascularized capitate bone transfer is an effective method for the treatment of Kienbock′s disease.

关 键 词：截骨术 月骨 头状骨移位 Kienb?ck病 

分 类 号：R687.3[医药卫生—骨科学]