抄録
In the treatment of Kienböck's disease in the progressive stage and in middle-and advanced-age patients, we selected replacement arthroplasty using a bone-cored fascial ball, while in Kienböck's disease in the early stage and in young patients we employed radial wedge osteotomy.
Since 1994, radial wedge osteotomy was performed on 8 patients, aged 20 to 38 years (average 26 years). Lichtman classification prior to operation was IIIA in 4 cases and IIIB in the other 4. Ulnar variance was zero in all patients, and radial wedge osteotomy of 15°and shortening of approximately 1mm were conducted. The postoperative follow-up period ranged from 7 months to 3 years and 2 months (average 1 year and 5 months).
Preoperatively, 3 patients had pain at rest and 7 had pain in movement, but at the time of follow-up, pain at rest had disappeared in 3, and pain in movement remained in only 1 patient. Range of motion of palmar and dorsal flexion of the hand joint increased from 83 to 98°: however, the increase was not significant. Grip, in comparison with the contralateral side, showed a significant average increase from 58 to 79%. Radiologically, carpal height ratio and Ståhl's index showed no change at follow-up when compared to the preoperative findings. No evidence of progression could be observed. According to Nakamura's evaluation criterion, the results were excellent in 2 cases, good in 4, and fair in 2. All 8 patients are now engaged in work.
For Kienböck's disease, this study proved that through radial wedge osteotomy in selected cases there was radiologically no progression in disease stage, and the clinical results were good.
