中华手外科杂志
中華手外科雜誌
중화수외과잡지
CHINESE JOURNAL OF HAND SURGERY
2013年
1期
10-12
,共3页
林松庆%黄惠梅%蔡镇德%徐皓
林鬆慶%黃惠梅%蔡鎮德%徐皓
림송경%황혜매%채진덕%서호
腕关节%月骨缺血性坏死%部分融合
腕關節%月骨缺血性壞死%部分融閤
완관절%월골결혈성배사%부분융합
Carpal joints%Kienbock disease%Partial fusion
目的 评价腕关节部分融合术治疗月骨缺血性坏死的临床疗效.方法 对12例月骨缺血性坏死的患者,按Lichtman分期,Ⅱ期7例,Ⅲ期5例,诊断至手术时间为7～40个月,平均20个月.术前所有患者均有不同程度的腕部疼痛、无力感,腕背侧轻度肿胀、压痛,活动功能障碍和握力减弱等临床表现,X线片显示:月骨不同程度囊性变、密度增高或边缘硬化.采用腕关节部分融合+钢板内固定术,术后3个月拆除石膏后行功能锻炼.结果 术后随访时间为6～18个月,平均12个月.所有患者伤口均Ⅰ期愈合,1例腕背部切口瘢痕增生.术后腕部疼痛、无力症状较术前明显好转,半年后随访X线片显示月骨形态正常、坏死区消失6例,明显缩小3例,部分缩小3例；舟-月-头状骨间隙消失,见骨性融合,桡腕关节间隙正常.腕关节疼痛程度采用视觉模拟评分法(visual analog scale,VAS)评分、活动度、握力均较术前改善,腕关节功能按Krimmer评分:优5例,良5例,可2例,优良率达83.3％.结论 腕关节部分融合术治疗月骨缺血性坏死效果确切,保留腕关节大部分功能,是一种较好的治疗方法.
目的 評價腕關節部分融閤術治療月骨缺血性壞死的臨床療效.方法 對12例月骨缺血性壞死的患者,按Lichtman分期,Ⅱ期7例,Ⅲ期5例,診斷至手術時間為7～40箇月,平均20箇月.術前所有患者均有不同程度的腕部疼痛、無力感,腕揹側輕度腫脹、壓痛,活動功能障礙和握力減弱等臨床錶現,X線片顯示:月骨不同程度囊性變、密度增高或邊緣硬化.採用腕關節部分融閤+鋼闆內固定術,術後3箇月拆除石膏後行功能鍛煉.結果 術後隨訪時間為6～18箇月,平均12箇月.所有患者傷口均Ⅰ期愈閤,1例腕揹部切口瘢痕增生.術後腕部疼痛、無力癥狀較術前明顯好轉,半年後隨訪X線片顯示月骨形態正常、壞死區消失6例,明顯縮小3例,部分縮小3例；舟-月-頭狀骨間隙消失,見骨性融閤,橈腕關節間隙正常.腕關節疼痛程度採用視覺模擬評分法(visual analog scale,VAS)評分、活動度、握力均較術前改善,腕關節功能按Krimmer評分:優5例,良5例,可2例,優良率達83.3％.結論 腕關節部分融閤術治療月骨缺血性壞死效果確切,保留腕關節大部分功能,是一種較好的治療方法.
목적 평개완관절부분융합술치료월골결혈성배사적림상료효.방법 대12례월골결혈성배사적환자,안Lichtman분기,Ⅱ기7례,Ⅲ기5례,진단지수술시간위7～40개월,평균20개월.술전소유환자균유불동정도적완부동통、무력감,완배측경도종창、압통,활동공능장애화악력감약등림상표현,X선편현시:월골불동정도낭성변、밀도증고혹변연경화.채용완관절부분융합+강판내고정술,술후3개월탁제석고후행공능단련.결과 술후수방시간위6～18개월,평균12개월.소유환자상구균Ⅰ기유합,1례완배부절구반흔증생.술후완부동통、무력증상교술전명현호전,반년후수방X선편현시월골형태정상、배사구소실6례,명현축소3례,부분축소3례；주-월-두상골간극소실,견골성융합,뇨완관절간극정상.완관절동통정도채용시각모의평분법(visual analog scale,VAS)평분、활동도、악력균교술전개선,완관절공능안Krimmer평분:우5례,량5례,가2례,우량솔체83.3％.결론 완관절부분융합술치료월골결혈성배사효과학절,보류완관절대부분공능,시일충교호적치료방법.
Objective To evaluate the effectiveness of partial wrist arthrodeses in treating Keinbock's disease.Methods There were 12 patients,8 males and 4 females.According to Lichtaan classification,7cases were stage Ⅱ while 5 cases were stage Ⅲ.The time interval between the diagnosis and the surgery was 7 to 40 months,with a mean of 20 months.All patients had symptoms including wrist pain,weakness,swelling on dorsum of the wrist,tenderness,movement limitation and reduced grip strength before the operation.X-rays showed cystic degeneration,high density or sclerotic margin of the lunate.The patients were treated by partial arthrodeses with the wrist fusion plate.The plaster cast was removed 3 months after the surgery when the patient started functional exercise.Results All the patients were follow-up for 6 to 18 months (average 12 months).Primary wound healing was observed in all 12 cases.One patient developed scar hyperplasia.Wrist pain and weakness greatly improved.X-rays taken 6 months postoperatively showed the form of lunate was normal.The necrosis area disappeared in 6 cases,obviously narrowed in 3 cases and partially narrowed in 3 cases.The scapho-luna-capitate space nearly disappeared and bone healing could be seen in all of them.The radiocarpal joint space was normal.The visual analog scale (VAS) of pain,wrist motion and grip strength were improved.According to the Krimmer score,5 cases got excellent results,5 cases good,and 2 cases poor,the satisfactory rate being 83.3％.Conclusion Partial wrist arthrodesis with fusion plate is a reliable procedure for treatment of Keinbock's disease.It leads to effective and satisfactory clinical results while preserving most wrist functions.
