CAJ | 학술논문

目的评估带血管蒂豌豆骨移位治疗月骨缺血性坏死的中长期疗效.方法 1993年7月至2005年6月,采用月骨切除带血管蒂豌豆骨移位治疗月骨缺血性坏死患者11例,男6例,女5例;年龄20～67岁,平均(41.0±14.3)岁.Lichtman月骨缺血性坏死分期:Ⅲa期4例,Ⅲb期5例,Ⅳ期2例.末次随访时评估腕痛主观感受、视觉模拟评分(visual analogue scale,VAS)、患侧腕关节活动度(range of motion,ROM)、握力、Cooney腕关节功能评分及影像学变化.结果患者随访61～202个月,平均(104.1±48.4)个月.10例患者腕痛缓解,7例达到基本无痛.疼痛VAS评分(2.2±1.9)分.患侧腕ROM为健侧的65.3%,握力为健侧的84.3%.Cooney腕关节功能评分优1例、良7例、可2例、差1例,优良率72.7%.X线片显示8例豌豆骨植入位置正常,2例向掌侧移位,1例向尺侧移位,舟豌豆间隙增宽;6例豌豆骨有正常骨小梁结构,3例萎缩变扁,2例有硬化改变;3例有骨关节炎改变.腕高比值、Nattrass指数较术前明显降低,桡舟角较术前增大,差异有统计学意义.结论采用月骨切除带血管蒂豌豆骨移位是治疗Ⅲ～Ⅳ期月骨缺血性坏死的一种有效方法.术后虽可出现腕骨塌陷,但患者主观满意度高,握力好.
목적 평고대혈관체완두골이위치료월골결혈성배사적중장기료효.방법 1993년7월지2005년6월,채용월골절제대혈관체완두골이위치료월골결혈성배사환자11례,남6례,녀5례;년령20～67세,평균(41.0±14.3)세.Lichtman월골결혈성배사분기:Ⅲa기4례,Ⅲb기5례,Ⅳ기2례.말차수방시평고완통주관감수、시각모의평분(visual analogue scale,VAS)、환측완관절활동도(range of motion,ROM)、악력、Cooney완관절공능평분급영상학변화.결과 환자수방61～202개월,평균(104.1±48.4)개월.10례환자완통완해,7례체도기본무통.동통VAS평분(2.2±1.9)분.환측완ROM위건측적65.3%,악력위건측적84.3%.Cooney완관절공능평분우1례、량7례、가2례、차1례,우량솔72.7%.X선편현시8례완두골식입위치정상,2례향장측이위,1례향척측이위,주완두간극증관;6례완두골유정상골소량결구,3례위축변편,2례유경화개변;3례유골관절염개변.완고비치、Nattrass지수교술전명현강저,뇨주각교술전증대,차이유통계학의의.결론 채용월골절제대혈관체완두골이위시치료Ⅲ～Ⅳ기월골결혈성배사적일충유효방법.술후수가출현완골탑함,단환자주관만의도고,악력호.
Objective To evaluate the long-term efficacy of vascularized pisiform transfer for patients with Kienb(o)ck's disease in Lichtman stages Ⅲ-Ⅳ. Methods Eleven patients were reviewed to analyze results after lunate resection and vascularized pisiform transfer for Lichtman stages Ⅲ and Ⅳ. There were six men and five women. Age ranged from 20 to 67 years with a average of 41.0±14.3 years. According to Lichtman stage. There were 4 cases in stage Ⅲa, 5 cases in stage Ⅲb, and 2 cases in stage Ⅳ. Assessment criteria included subjective assessment of pain, visual analogue scale (VAS), range of motion (ROM), grip power,Cooney wrist score and radiographic changes on each follow-up visit. The radiographic changes including pis iform bone location, shape, sclerosis change, osteoarthritis, carpal height ratio, Nattrass index, Radioscaphoid angle and ulnar variance were recorded. Results The follow-up periods of all of cases were 61-202 months,with an average of 104.1 months. Pain had improved in 10 patients and disappeared in 7 cases. The VAS score was 2.2±1.9 at follow-up visit. Range of motion of injured wristw as only 65.3% of opposite side. Grip power was 84.3% of the contralateral hand. According to Cooney score, the results were excellent in 1 case, good in 7cases, fair in 2 cases and poor in 1 case, with the excellent and good rate of 72.7%. Radiologically, 8 cases had normal position of the pisiform bone, 2 had volar displacement and 1 had ulnar displacement which leaded to widen scaphopisiform space. Six pisiform bones had normal trabecular structure, three had degenerative changes. Bone sclerosis was seen in 2 cases and osteoarthritis was found in 3 patients. Compared with radiographic parameter before surgery, carpal height ratio and Nattrass index significantly lowered and radioscaphoid angle significantly increased. Conclusion Lunate resection and vascularized pisiform transfer is an effective method for Kienb(o)k′s disease in stages Ⅲ-Ⅳ. Although carpal collapse appeared postoperatively,the results show high patient satisfaction and good function after vascularized bone transplantation.