Kienböck 病に対する橈骨骨切り術

橈骨短縮術と橈骨楔状骨切り術の比較検討

抄録

In this paper, we reviewed our patients with Kienböck's disease who had had radial shortening osteotomy and radial wedge osteotomy, and compared the two procedures.
Since 1981 we have performed radial osteotomy on 40 patients, 32 males and 8 females, with an average age of 40.3 years (range: 15-63). Radial shortening osteotomy (RS group) was carried out in 17 patients with ulnar minus variance and radial wedge osteotomy (RW group) for 23 patients with ulnar zero and plus variance. According to Lichtman's classification, two of the 17 patients in the RS group were at stage II, 12 at stage III and 3 at srage IV. One of 23 patients in the RW group was at stage II, 20 at stsge III and 2 at stage IV. We reviewed the clinical symptoms and radiological findings and evaluated the results according to Nakamura's scoring system. Ulnar variance, radial inclination and ulnar shift ratio were measured in P-A roentgenograms and the correlation between these factors and the clinical results was investigated.
Average follow-up time was 4.1 years in the RS group and 3.2 years in the RW group.
Six of 17 cases in the RS group were rated excellent, 6 good, 2 fair and 3 poor. Five of 23 cases in the RW group were rated excellent, 6 good and 12 fair. There was no significant difference between two procedures regarding clinical results.
The average postoperative radial inclination was 23.1° in the RS group. The average postoperative radial inclination in the RW group was 17.0° in consequence of the 9° wedge osteotomy. There was no significant correlation between postoperative radial inclination and clinical results in both groups, however, the radial inclination in cases rated excellent and good ranged from 10° to 20°. The average preoperative ulnar variance was minus 1.2mm in the RS group and minus 0.6mm in the RW group. The average postoperative ulnar variance was plus 0.4mm in the RS group and minus 0.5mm in the RW group. There was no statistical correlation between preoperative, postoperative ulnar variance, the amount of shortening and clinical results. The average ulnar shift ratio was 0.16 preoperatively and 0.15 postoperatively in the RS group. In the RW group, the average ulnar shift ratio was 0.13 preoperatively and 0.08 postoperatively, which indicated the radial shift of the lunate. There was significant correlation between radial inclination and ulnar shift ratio indicating that radial inclination was smaller, the lunate moved more radially. In the RW group, there was significant correlation between ulnar shift ratio and clinical results, that is, radial wedge osteotomy with the lunate shifted radially achieved satisfactory results.