Herbert钉内固定联合植骨并肌腱团填塞治疗Lichtman Ⅲb期月骨缺血性坏死
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摘要
目的探讨Herbert钉内固定联合植骨局限性融合腕舟头关节并掌长肌腱团填塞治疗Lichtman Ⅲb期月骨缺血性坏死的临床疗效。方法回顾性分析自2011-10—2015-10诊治的10例Lichtman Ⅲb期月骨缺血性坏死,采用腕背侧入路摘除坏死的月骨,切除桡骨茎突植骨于舟头关节间隙,用Herbert钉固定舟头关节,取掌长肌腱团填塞月骨空隙。结果术后10例均获得随访,随访时间平均13.5(10~18)个月。所有患者腕部疼痛症状完全消失,术后腕骨高度与术前比较无明显差异,未发现腕关节炎。X线片显示腕部舟头关节局部融合满意,融合时间平均9.2周。末次随访时患侧手握力35.6 kg,较术前明显改善。末次随访时腕关节活动范围:背伸平均47.0°,掌屈平均55.0°,尺偏平均28.0°,桡偏平均9.0°。末次随访时腕关节功能根据中华医学会手外科学会上肢部分功能标准评定:优4例,良4例,可2例。结论采用Herbert钉内固定联合植骨局限性融合腕舟头关节并掌长肌腱团填塞治疗Lichtman Ⅲb期月骨缺血性坏死可有效缓解腕部疼痛,提高腕部握力,改善腕关节的活动范围。
Objective To explore the clinical effects of Herbert screw fixation with bone graft and tendon interposition in the treatment of Lichtman stage Ⅲb lunate necrosis. Methods From October 2011 to October 2015, ten patients with Lichtman stage Ⅲ b lunate necrosis were enrolled in this study. All patients underwent necrotic lunate excising through wrist dorsal approach, radial styloid grafting in scaphocapitate joint space, scaphocapitate joint fixing with Herbert screw and palm tendon group filling in lunar void. Results The patients were followed up for an average of 13.5 months(rang, 10-18 months). All patients with wrist pain symptoms completely disappeared. No significant difference in the carpal bony height before and after operation. There were no signs of wrist arthritis. X-ray showed satisfactory scaphocapitate fusion, the fusion time averaged 9.2 weeks. Mean grip strength was 35.6 kg at last follow-up, significantly improved after operation. The rang of wrist motion at the final follow-up, dorsal extension averaged 47°, palmar flexion 55°, ulnar deviation 28°, radial deviation 9°. The efficacy was evaluated according to the Chinese Medical Association Society of Hand Surgery of upper limb function assessment, excellent in 4 cases, good in 4 cases, and poor in 2 cases. Conclusion Herbert screw fixation with bone graft and tendon interposition for treatment of Lichtman stage Ⅲb lunate necrosis is an effective method. The surgical method can effectively relieve wrist pain, improve grip strength and wrist range of motion.
Objective To explore the clinical effects of Herbert screw fixation with bone graft and tendon interposition in the treatment of Lichtman stage Ⅲb lunate necrosis. Methods From October 2011 to October 2015, ten patients with Lichtman stage Ⅲ b lunate necrosis were enrolled in this study. All patients underwent necrotic lunate excising through wrist dorsal approach, radial styloid grafting in scaphocapitate joint space, scaphocapitate joint fixing with Herbert screw and palm tendon group filling in lunar void. Results The patients were followed up for an average of 13.5 months(rang, 10-18 months). All patients with wrist pain symptoms completely disappeared. No significant difference in the carpal bony height before and after operation. There were no signs of wrist arthritis. X-ray showed satisfactory scaphocapitate fusion, the fusion time averaged 9.2 weeks. Mean grip strength was 35.6 kg at last follow-up, significantly improved after operation. The rang of wrist motion at the final follow-up, dorsal extension averaged 47°, palmar flexion 55°, ulnar deviation 28°, radial deviation 9°. The efficacy was evaluated according to the Chinese Medical Association Society of Hand Surgery of upper limb function assessment, excellent in 4 cases, good in 4 cases, and poor in 2 cases. Conclusion Herbert screw fixation with bone graft and tendon interposition for treatment of Lichtman stage Ⅲb lunate necrosis is an effective method. The surgical method can effectively relieve wrist pain, improve grip strength and wrist range of motion.
引文
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[4]朱勇,杨英才,王博.桡侧腕短伸肌腱团填塞术治疗月骨坏死远期疗效[J].中华手外科杂志,2015,31(6):430-432.
[5]Daecke W,Lorenz S,Wieloch P,et al.Vascularized os pisiform for reinforcement of the lunate in Kienbock's disease:an average of 12years of follow-up study[J].J Hand Surg Am,2005,30(5):915-922.
[6]徐永清,颜翼,朱跃良,等.镍钛记忆合金舟大小融合器治疗舟骨旋转性半脱位和月骨无菌性坏死的应用研究[J].实用手外科杂志,2012,26(3):207-211.
[7]邓爱东,顾剑辉,陈情忠.腕舟头骨局限性融合治疗Ⅲ期月骨无菌性坏死的长期随访研究[J].中华手外科杂志,2014,30(3):180-184.
[8]Watson HK,Wollstein R,Joseph E,et al.Scaphotrapeziotrapeziod arthrodesis:a follow-up study[J].J Hand Surg Am,2003,28(3):397-404.
[9]Budoff JE,Gable G.Ulnar translation of scaphocapitate arthrodeses in Kienbock's disease--two case reports[J].J Hand Surg Am,2005,30(1):65-68.
[10]Sennwald GR,Ufenast H.Scaphocapitate arthrodesis for the treatment of Kienbock's disease[J].J Hand Surg Am,1995,20(3):506-510.
[2]李春梅,王桂芝,王禹增,等.自体骨肌腱腱膜团填塞治疗月骨缺血性坏死[J].中国骨与关节损伤杂志,2008,23(2):129-130.
[3]朱晓东,王兆林,高天勤,等.带蒂腕豆骨移植治疗月骨无菌性坏死11例初步观察报告[J].中国矫形外科杂志,2007,15(6):479-480.
[4]朱勇,杨英才,王博.桡侧腕短伸肌腱团填塞术治疗月骨坏死远期疗效[J].中华手外科杂志,2015,31(6):430-432.
[5]Daecke W,Lorenz S,Wieloch P,et al.Vascularized os pisiform for reinforcement of the lunate in Kienbock's disease:an average of 12years of follow-up study[J].J Hand Surg Am,2005,30(5):915-922.
[6]徐永清,颜翼,朱跃良,等.镍钛记忆合金舟大小融合器治疗舟骨旋转性半脱位和月骨无菌性坏死的应用研究[J].实用手外科杂志,2012,26(3):207-211.
[7]邓爱东,顾剑辉,陈情忠.腕舟头骨局限性融合治疗Ⅲ期月骨无菌性坏死的长期随访研究[J].中华手外科杂志,2014,30(3):180-184.
[8]Watson HK,Wollstein R,Joseph E,et al.Scaphotrapeziotrapeziod arthrodesis:a follow-up study[J].J Hand Surg Am,2003,28(3):397-404.
[9]Budoff JE,Gable G.Ulnar translation of scaphocapitate arthrodeses in Kienbock's disease--two case reports[J].J Hand Surg Am,2005,30(1):65-68.
[10]Sennwald GR,Ufenast H.Scaphocapitate arthrodesis for the treatment of Kienbock's disease[J].J Hand Surg Am,1995,20(3):506-510.