| Treatment of Stage III Kienböck’s Disease with Vascularized Bone Graft |
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Dong Chul Kim, Churl Hong Chun, Ha Heon Song, Sung Hun Kim, Young Cheon Na, Jae Hyun Park |
| 혈관부착 골이식술을 이용한 제 3기 Kienböck병의 치료 |
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김동철, 전철홍, 송하헌, 김성훈, 나영천, 박재현 |
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| Abstract |
Purpose
We analysed clinically the efficiency of a vascularized bone graft for restoring the contour of the collapsed lunate and improving the clinical outcomes in stage 3 Kienböck’s disease. Materials and Methods: 5 patients with stage 3 Kienböck’s disease were treated by debridement of the necrotic core of the lunate and implantation of a vascularized bone harvested on ipsilateral third metacarpal base with it’s dorsal metacarpal artery. As a additional procedures, temporalily STT (scaphotrapezial-trapezoid) fixation and radial shortening for 2 cases respectively were done simultaneously with vascularized bone graft for reducing a load across the radiocarpal joint. The mean follow up period were 4.7 (2.6-6.8) years. Of the 5 cases, 3 were men and 2 women, with mean age of 42 (28-68) years. All were affected in the dominant and. This disease was diagnosed using standard P-A and lateral wrist radiographs and was staged according to the Lichtman’s classification. We assessed the results with clinical outcomes and radiograph. Results: Three of the 5 patients were satisfied with the outcomes of this treatment and showed functional improvement. These patients returned to thier normal or usual activities. Grip strength was satisfactory and range of motion improved following surgery. One of them who was treated with vascularized bone graft only complained of a mild pain with strenuous activity in the working but no problems in the activity of daily living. Other 2 patients who had temporalily STT fixation as a additional procedure also showed improved clinical symptoms and grip power after surgery, but they complained of pain and limitation of motion in spite of improved clinical outcomes compared with previous symptoms. Re-collapse of lunate and decrease in carpal height ration was not showed at the last follow up radiologic assessment in all cases. Conclusion: Vascularized bone graft with additional procedures for reducing radiocarpal load is an effective procedure for relief or reduction of pain in stage 3 Kienböck’s disease and restoring the contour of the collapsed lunate. And radial shortening is better than temporalily STT fixation as a additional procedure from the viewpoint of etiology. |
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