Kienböck Disease: Recent Advances in Understanding and Management.

David M Lichtman,William F Pientka
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Abstract

➢ An at-risk lunate (due to anatomic factors) subjected to a trigger event (axial load, embolism, hypercoagulability) leads to the development of lunate osteonecrosis.➢ Children, adolescents, and elderly patients with Kienböck disease respond well to nonoperative treatments, and this should be considered before any surgical intervention.➢ For disease limited to the lunate, treatment decisions should be driven by the condition of the cartilage; intact lunate cartilage can be treated with joint leveling or core decompression, whereas disrupted cartilage surfaces should be bypassed with scaphocapitate or scaphotrapeziotrapezoid arthrodesis. Newer surgical procedures such as wrist arthroscopy and the introduction of contrast-enhanced magnetic resonance imaging have expanded the treatment options for these patients.➢ Once disease extends outside of the lunate, reconstruction with proximal row carpectomy or partial or total wrist arthrodesis should be considered on the basis of which articular surfaces are affected.➢ The new unified classification system and treatment are applicable to almost all patients with Kienböck disease.
Kienböck疾病:理解和管理的最新进展。
(四)有危险的月骨(由于解剖因素)受到触发事件(轴向负荷、栓塞、高凝性)的影响,导致月骨坏死的发生。(四)儿童、青少年、老年Kienböck患者对非手术治疗反应良好,应在手术治疗前予以考虑。(四)对于限于月骨的疾病,应根据软骨状况决定治疗方案;完整的月骨软骨可通过关节整平或核心减压治疗,而受损的软骨表面应通过舟头关节或舟斜方-梯形关节融合术绕过。较新的外科手术,如手腕关节镜检查和增强磁共振成像的引入,扩大了这些患者的治疗选择。(四)一旦疾病扩展到月骨以外,应根据受影响的关节面考虑行近端腕骨切除术或部分或全部腕关节融合术重建。(四)新的统一分类制度和治疗方法适用于几乎所有Kienböck疾病患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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