中华手外科杂志
中華手外科雜誌
중화수외과잡지
CHINESE JOURNAL OF HAND SURGERY
2014年
3期
180-184
,共5页
月骨%骨坏死%关节固定术%功能评价
月骨%骨壞死%關節固定術%功能評價
월골%골배사%관절고정술%공능평개
Lunate bone%Osteonecrosis%Arthrodesis%Functional assessment
目的 通过对腕舟头骨局限性融合治疗Ⅲ期月骨无菌性坏死进行长期随访研究,评价其远期疗效.方法 2003年10月至2006年11月对8例Ⅲ期月骨无菌性坏死患者采用腕舟头局限性腕骨融合进行治疗,术后平均随访时间为85.3个月(66～ 118个月).所有患者术前、术后均进行腕关节运动范围和握力测定,并进行Gartland-Werley腕关节功能评定及DASH评分.结果 术后所有患者腕痛完全缓解,均能够胜任原工作.腕关节活动范围:术前背伸51.3°±15.3°,术后背伸45.5°±15.7°;术前掌屈43.1°±5.3°,术后掌屈34.0°±10.0°;术前旋前75.6°±8.6°,术后旋前76.9°±10.0°;术前旋后76.3°±10.3°,术后旋后79.4°±11.2°;术前尺偏17.5°±2.7°,术后尺偏17.6°±3.5°;术前桡偏13.1°±7.5°,术后桡偏11.9°±8.0°.统计表明手术前后腕关节运动范围没有明显降低.术前握力为(8.1±6.9)kg,术后握力为(31.3±7.3) kg; Gartland-Werley腕关节评分术前为13.1±2.4,术后为5.6± 3.8; DASH评分术前为21.8±3.0,术后为8.6±5.5,统计表明握力、腕关节评分及DASH评分均得到显著改善.X线检查腕高比没有明显的降低,无一例患者发生腕关节退变性关节炎.结论 应用舟头局限性腕骨融合术治疗Ⅲ期月骨无菌性坏死能够有效缓解腕关节疼痛,提高握力,但是腕关节活动范围并无改善.
目的 通過對腕舟頭骨跼限性融閤治療Ⅲ期月骨無菌性壞死進行長期隨訪研究,評價其遠期療效.方法 2003年10月至2006年11月對8例Ⅲ期月骨無菌性壞死患者採用腕舟頭跼限性腕骨融閤進行治療,術後平均隨訪時間為85.3箇月(66～ 118箇月).所有患者術前、術後均進行腕關節運動範圍和握力測定,併進行Gartland-Werley腕關節功能評定及DASH評分.結果 術後所有患者腕痛完全緩解,均能夠勝任原工作.腕關節活動範圍:術前揹伸51.3°±15.3°,術後揹伸45.5°±15.7°;術前掌屈43.1°±5.3°,術後掌屈34.0°±10.0°;術前鏇前75.6°±8.6°,術後鏇前76.9°±10.0°;術前鏇後76.3°±10.3°,術後鏇後79.4°±11.2°;術前呎偏17.5°±2.7°,術後呎偏17.6°±3.5°;術前橈偏13.1°±7.5°,術後橈偏11.9°±8.0°.統計錶明手術前後腕關節運動範圍沒有明顯降低.術前握力為(8.1±6.9)kg,術後握力為(31.3±7.3) kg; Gartland-Werley腕關節評分術前為13.1±2.4,術後為5.6± 3.8; DASH評分術前為21.8±3.0,術後為8.6±5.5,統計錶明握力、腕關節評分及DASH評分均得到顯著改善.X線檢查腕高比沒有明顯的降低,無一例患者髮生腕關節退變性關節炎.結論 應用舟頭跼限性腕骨融閤術治療Ⅲ期月骨無菌性壞死能夠有效緩解腕關節疼痛,提高握力,但是腕關節活動範圍併無改善.
목적 통과대완주두골국한성융합치료Ⅲ기월골무균성배사진행장기수방연구,평개기원기료효.방법 2003년10월지2006년11월대8례Ⅲ기월골무균성배사환자채용완주두국한성완골융합진행치료,술후평균수방시간위85.3개월(66～ 118개월).소유환자술전、술후균진행완관절운동범위화악력측정,병진행Gartland-Werley완관절공능평정급DASH평분.결과 술후소유환자완통완전완해,균능구성임원공작.완관절활동범위:술전배신51.3°±15.3°,술후배신45.5°±15.7°;술전장굴43.1°±5.3°,술후장굴34.0°±10.0°;술전선전75.6°±8.6°,술후선전76.9°±10.0°;술전선후76.3°±10.3°,술후선후79.4°±11.2°;술전척편17.5°±2.7°,술후척편17.6°±3.5°;술전뇨편13.1°±7.5°,술후뇨편11.9°±8.0°.통계표명수술전후완관절운동범위몰유명현강저.술전악력위(8.1±6.9)kg,술후악력위(31.3±7.3) kg; Gartland-Werley완관절평분술전위13.1±2.4,술후위5.6± 3.8; DASH평분술전위21.8±3.0,술후위8.6±5.5,통계표명악력、완관절평분급DASH평분균득도현저개선.X선검사완고비몰유명현적강저,무일례환자발생완관절퇴변성관절염.결론 응용주두국한성완골융합술치료Ⅲ기월골무균성배사능구유효완해완관절동통,제고악력,단시완관절활동범위병무개선.
Objective To evaluate the long term results of scaphocapitate arthrodesis for the treatment of Lichtman stage Ⅲ Kienb(o)ck's disease.Methods Between October 2003 and November 2006,8 cases of stage Ⅲ Kienb(o)ck's disease were treated with scaphocapitate arthrodesis.Postoperative follow-up was an average of 85.3 months (range,66 to 118 months).Clinical evaluation included preoperative and postoperative range of motion,grip strength,Disabilities of the Arm,Shoulder and Hand (DASH) scores and Gartland-Werley wrist scores.Radiographic evaluation included carpal height ratio and signs of wrist joint degenerative arthritis.Results All the patients reported an improvement in their symptoms and were pain free after the operation.They were able to return to their work.Wrist range of motion was 51.3° ± 15.3°preop vs 45.5° ± 15.7°postop for extension,43.1° ± 5.3°preop vs 34.0° ± 10.0°postop for flexion,75.6° ± 8.6°preop vs 76.9° ± 10.0°postop for pronation,76.3° ± 10.3°preop vs 79.4° ± 11.2°postop for supination,17.5° ± 2.7°preop vs 17.6° ± 3.5° postop for unlar deviation,and 13.1° ± 7.5°preop vs 11.9° ± 8.0°postop for radial deviation.There was no significant difference in the pre-and post-operative wrist motion.Grip strength was (8.1 ± 6.9) kg preoperatively and (31.3 ± 7.3) kg postoperatively.Gartland-Werley scores changed from 13.1 ± 2.4 to 5.6 ± 3.8,while DASH scores from 21.8± 3.0 to 8.6 ± 5.5.Improvements in grip strength,Gartland-Werley scores and DASH scores were all statistically significant.Radiographically there was no significant change in carpal height ratio and no joint degenerative arthritis.Conclusion For stage Ⅲ Kienb(o)ck's disease scaphocapitate arthrodesis can alleviate wrist pain,improve grip strength and DASH and Gartland-Werley scores.It however does not improve wrist range of motion.
