关节镜下月骨切除术治疗3期基尼伯克病

Pub Date : 2023-09-11 DOI:10.1055/s-0043-1772253
L. Merlini, J. Maffeis, C. Mathoulin, B.S. Sivakumar
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引用次数: 0

摘要

背景:3期Kienbock病的理想治疗方法尚不确定,目前的开放式手术有腕关节不稳定、尺关节脱位和僵硬的风险。我们介绍了关节镜下月骨切除术的技术,并讨论了我们的中短期效果。技术描述:通过标准的腕关节镜入口,使用刮刀、毛刺和咬合钳联合切除月骨。要注意保护月骨的极端背侧和掌侧皮质,以防止腕关节不稳定。短臂背板固定2周后,患者开始活动范围。患者和方法在法国巴黎的一个中心接受关节镜月骨切除术的连续患者进行了术前和术后评估。评估的参数包括活动范围,以及患者报告的结果测量(PROMs)。结果13例患者(女7例,男6例,平均年龄27.2岁)行关节镜下月骨切除术,平均随访1.96年。在屈曲、伸展、旋前、握力和PROMs方面均有显著改善。结论关节镜下肺切除术在中短期随访中可显著改善临床和PROMs,并在手术失败时保留其他挽救选择。长期的临床随访和进一步的生物力学研究将是有益的。
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Arthroscopic Lunate Excision for Stage 3 Kienbock's Disease
Abstract Background The ideal treatment of stage 3 Kienbock's disease is uncertain, with current open procedures conferring the risk of carpal instability, ulnar translocation, and stiffness. We present our technique of arthroscopic lunate excision, and discuss our short- to medium-term results. Description of Technique Via standard wrist arthroscopic portals, the lunate is excised using a combination of shavers, burrs, and rongeurs. Care is taken to preserve the extreme dorsal and volar cortices of the lunate to prevent carpal instability. A short arm backslab is applied for 2 weeks, after which the patient commences range of motion. Patients and Methods Consecutive patients undergoing arthroscopic lunate excision at a single center in Paris, France, underwent pre- and postoperative assessment. Parameters assessed include range of motion, as well as patient-reported outcome measures (PROMs). Results A cohort of 13 patients (7 females and 6 males with a mean age of 27.2 years) underwent arthroscopic lunate excision, and were followed up for a mean of 1.96 years. Significant improvements were noted in flexion, extension, pronation, grip strength, and PROMs. Conclusions Arthroscopic lunectomy provides significant improvements in clinical and PROMs at short- to medium-term follow-up, and conserves other salvage options in case of failure. Long-term clinical follow-up and further biomechanical studies would be beneficial.
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