進行期キーンベック病に対するとう骨くさび状骨切り術の治療成績とＸ線解析の検討

Abstract

The treatment of advanced stages of Kienbock's disease (stage III-B and IV according to Lichtman's classification) consists of several methods. We performed radial closing wedge osteotomy for eleven patients with advanced stages of Kienbock's disease from 1990 to 1998. Seven patients were followed up for more than 6 months. All patients were female with an average age of 50.1 years. Five were stage III-B and 2 were stage IV. All patients underwent radial wedge osteotomy. The average follow-up was 3.5 years. Pain in the wrist, grip strength and wrist range of motion were assessed preand post operatively and Nakamura's scoring system was applied as postoperative clinical status. The following measurements were made pre-and postoperatively for radiographic assessment: the carpal height ratio, Stahl's index, carpal-ulnar distance ratio, lunate covering ratio, radio-lunate angle, scapho-lunate angle, and radio-scaphoid angle. All patients were relieved from pain of the wrist and returned to their original jobs. Grip strength improved from 54% to 95% of the opposite wrist. Wrist motion also improved, with the flexion-extion arc, from 60% to 83% of the opposite side. Clinical results were good in 4, fair in 2 and poor in 1 patients using the Nakamura's scoring system. The carpal height ratio and Stahl'S index decreased from 0.48 to 0.45 and from 33% to 27%, respectively, both without statistical significance. The carpal-ulnar distance ratio and the lunate covering ratio increased significantly (p<0.002), from 0.29 to 0.39 and from 68% to 84%, respectively. In addition, the radio-scaphoid angle was improved from 75.1° to 67.1° with statistical significance (p<0.01). Furthermore, the improvement of the radio-scaphoid angle and Nakamura's postoperative clinical score correlated significantly (p<0.001). Our study demonstrates that radial closing wedge osteotomy offers the advantage of improving not only wrist symptoms but also scaphoid rotation in patients with advanced Kienbock's disease.