镍钛记忆合金三脚固定器治疗月骨缺血性坏死的远期疗效  

Long-term effectiveness of Ni-Ti memory alloy tripod fixator in treatment of Kienböck disease

作　　者：宋慕国 徐永清 何晓清 李川 SONG Muguo;XU Yongqing;HE Xiaoqing;LI Chuan(Department of Orthopaedic,920th Hospital of Joint Logistics Support Force of Chinese PLA,Kunming Yunnan,650032,P.R.China;Graduate School of Kunming Medical University,Kunming Yunnan,650500,P.R.China)

机构地区：[1]中国人民解放军联勤保障部队第九二〇医院骨科,昆明650032 [2]昆明医科大学研究生院,昆明650500

出　　处：《中国修复重建外科杂志》2024年第9期1059-1064,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：云南省创伤骨科临床医学中心项目(ZX20191001);云南省骨科与运动康复临床医学研究中心项目(202102AA310068);军队后勤科研重点项目(桂战办[2022]188号);全军临床重点专科建设项目;联勤医学重点专科项目。

摘　　要：目的探讨镍钛记忆合金三脚固定器治疗月骨缺血性坏死(Kienb?ck病)的远期疗效。方法回顾分析2011年1月—2013年9月采用镍钛记忆合金三脚固定器治疗且随访10年以上的22例Kienb?ck病患者临床资料。男14例,女8例;年龄20~64岁,平均45岁。Lichtman分期均为Ⅲb期。按照国际内固定研究协会(AO/ASIF)分型:B1型6例,B2型2例,B3型10例,C2型4例。病程18~50个月,平均30.7个月。记录患者手术时间、术中出血量及并发症发生情况。手术前后通过腕关节正侧位X线片测量腕关节高度比及舟月角;通过Jamar测力计测量双手握力;采用疼痛视觉模拟评分(VAS)评价腕关节疼痛程度,Mayo评分评估腕关节功能,并测量腕关节桡偏、尺偏、背伸、掌屈活动度。结果手术时间45~60 min,平均52.21 min;术中出血量50~60 mL,平均58.63 mL。术中未发生神经、血管损伤。22例均获随访,随访时间10~13年,平均11.3年。术后3个月X线片示月骨密度较术前降低。术后3~6个月(平均4.5个月)舟骨和大-小多角骨实现了满意融合,融合后腕关节高度比和舟月角均较术前显著改善,差异有统计学意义(P<0.05)。术后患者腕关节疼痛均得到缓解,舟骨旋转和脱位情况也得到改善,随访期间未发现桡腕关节退行性改变,无内固定物松动、断裂或月骨持续坏死加重等情况发生。末次随访时,患者腕关节桡偏、尺偏、背伸、掌屈活动度及VAS评分、患侧握力均较术前显著改善,差异有统计学意义(P<0.05);患侧握力达健侧的99.00%±1.25%。Mayo评分为72~93分,平均85分;获优14例、良5例、满意3例,优良率86.4%。结论使用镍钛记忆合金三脚固定器行舟-大-小多角骨融合术治疗Ⅲb期Kienb?ck病,能有效融合且显著减轻患者疼痛、改善手部功能并防止进一步恶化,可获得良好远期疗效。Objective To investigate the long-term effectiveness of Ni-Ti memory alloy tripod fixator in the treatment of Kienböck disease.Methods The clinical data of 22 patients with Kienböck disease who were treated with Ni-Ti memory alloy tripod fixator between January 2011 and September 2013 and followed up more than 10 years was retrospectively analyzed.There were 14 males and 8 females with an average age of 45 years(range,20-64 years).The Lichtman staging was stageⅢb.According to AO/Association for the Study of Internal Fixation(AO/ASIF)classification,there were 6 cases of type B1,2 cases of type B2,10 cases of type B3,and 4 cases of type C2.The disease duration ranged from 18 to 50 months,with an average of 30.7 months.The operation time,intraoperative blood loss,and complications were recorded.Wrist height ratio and scapholunate angle were measured by wrist anteroposterior and lateral X-ray films before and after operation.The grip strength of bilateral hands was measured by Jamar dynamometer.The wrist pain was evaluated by visual analogue scale(VAS)score,and the wrist function was evaluated by Mayo score,and the radial deviation,ulnar deviation,dorsiflexion,and palmar flexion range of motion of wrist were measured.Results The operation time was 45-60 minutes,with an average of 52.21 minutes;the intraoperative blood loss was 50-60 mL,with an average of 58.63 mL.No nerve or blood vessel injury occurred during operation.All patients were followed up 10-13 years(mean,11.3 years).X-ray films at 3 months after operation showed that the density of lunate bone was lower than that before operation.Satisfactory fusion of the scapho-trapezio-trapezoeid joint was achieved at 3-6 months after operation(mean,4.5 months),and the wrist height ratio and the scapholunate angle after fusion significantly improved when compared with those before operation(P<0.05).Wrist pain relieved,scaphoid rotation and dislocation improved,and no radiocarpal joint degeneration was found during follow-up,and no internal fixator loosening,breakag

关 键 词：腕关节 月骨缺血性坏死 镍钛记忆合金三脚固定器 远期疗效 

分 类 号：R687.4[医药卫生—骨科学]