LONG-TERM EFFECTIVENESS OF VASCULARIZED CAPITATE OSTEOTOMY TRANSPOSITION FOR ADVANCED Kienb?ck's DISEASE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANGShitian ¹ ,  LIUGang ¹ , ZHANGDingwei ¹ , WANGJun ¹ , HUANGFuguo ²

1. Department of Orthopaedics, Mianyang Central Hospital, Mianyang Sichuan, 621000, P. R. China;
2. Department of Orthopaedics West China Hospital, Sichuan University, Mianyang Sichuan, 621000, P. R. China;

Corresponding?author：

LIUGang, Email: liugang618@163.com

Keywords：

Kienb?ck's disease; Vascularized capitate osteotomy transposition; Long-term effectiveness

DOI：

10.7507/1002-1892.20140203

Video：

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Objective To evaluate the long-term effectiveness of lunate excision and vascularized capitate osteotomy transposition for advanced Kienb?ck's disease. Methods Between June 2004 and January 2008,16 patients with Kienb?ck disease in Lichtman stages ⅢB-IV were treated with lunate excision and vascularized capitate osteotomy transposition.There were 10 males and 6 females at the age of 27-59 years (mean,38.8 years).The disease was caused by trauma in 10 cases,and unknown reason in 6 cases.The main clinical symptoms were pain and limited activity of the wrist joint,and the disease duration was 5-32 months (mean,26.5 months).The carpal height index was 0.88±0.05; the radioscaphoid angle was (63.8±9.1)°.The visual analogue scale (VAS) score,range of motion (ROM),grip strength,Evans score,and radiographic changes were used to assess the effectiveness during follow-up. Results All patients obtained healing of incision by first intention and were followed up 5 years and 4 months to 9 years (mean,5.8 years).VAS score was 2.0±1.5 at the final follow-up.The ROM of the flexion and extension of the wrist joint at the affected side were significantly less than those at the normal side (P<0.05).However,no significant difference was found in the grip strength and Evans score between the affected side and normal side (t=-0.997,P=0.327; t=-1.852,P=0.077).Postoperative radiographs showed that the carpal height index was 0.94±0.03,and the radioscaphoid angle was (48.4±4.8)°,which were improved significantly when compared with preoperative ones (t=-3.927,P=0.000; t=5.987,P=0.000).Osteophyte at the dorsal side of the radius and scaphoid rotation occurred in 6 cases and 2 cases,respectively. Conclusion Lunate excision and vascularized capitate osteotomy transposition is a reliable method for advanced Kienb?ck's disease,with favorable improvement in wrist pain and grip strength for long-term follow-up.

Citation： TANGShitian, LIUGang, ZHANGDingwei, WANGJun, HUANGFuguo. LONG-TERM EFFECTIVENESS OF VASCULARIZED CAPITATE OSTEOTOMY TRANSPOSITION FOR ADVANCED Kienb?ck's DISEASE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 925-928. doi: 10.7507/1002-1892.20140203 Copy

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2.	Lu L,Gong X,Liu Z,et al.Capitate transposition to replace necrotic lunate bone with a pedicle for Kienb?ck's disease:review of 30 cases.Chin Med J (Engl),2003,116(10):1519-1522.
3.	Evans G,Burke FD,Barton NJ.A comparison of conservative treatment and silicone replacement arthroplasty in Kienb?ck's disease.J Hand Surg (Br),1986,11(1):98-102.
4.	Stahelin A,Pfeiffer K,Sennwald G,et al.Determining carpal collapse.An improved method.J Bone Joint Surg (Am),1989,71(9):1400-1405.
5.	Linscheid RL,Dobyns JH,Beabout JW,et al.Traumatic instability of the wrist.Diagnosis,classification,and pathomechanics.J Bone Joint Surg (Am),1972,54(8):1612-1632.
6.	Armistead RB,Linscheid RL,Dobyns JH,et al.Ulnar lengthening in the treatment of Kienb?ck's disease.J Bone Joint Surg (Am),1982,64(2):170-178.
7.	Gay AM,Parratte S,Glard Y,et al.Isolated capitate shortening osteotomy for the early stage of Kienb?ck disease with neutral ulnar variance.Plast Reconstr Surg,2009,124(2):560-566.
8.	Hierner R,Wilhelm K.Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage Ⅲ lunate necrosis.Strategies Trauma Limb Reconstr,2010,5(1):23-29.
9.	Sakai A,Toba N,Oshige T,et al.Kienb?ck disease treated by excisional arthroplasty with a palmaris longus tendon ball:a comparative study of cases with or without bone core.Hand Surg,2004,9(2):145-149.
10.	Saffar P.Vascularized pisiform transfer in place of lunatum for Kienb?ck's disease.Chir Main,2010,29 Suppl 1:S112-S118.
11.	肖聰,劉國明,滕林,等.帶血管蒂豌豆骨瓣移位治療月骨缺血性壞死的中長期療效評估.中華骨科雜志,2011,31(3):238-242.
12.	Lu LJ,Gong X,Wang KL.Vascularized capitate transposition for advanced Kienb?ck disease:application of 40 cases and their anatomy.Ann Plast Surg,2006,57(6):637-641.
13.	Takase K,Imakiire A.Lunate excision,capitate osteotomy,and intercarpal arthrodesis for advanced Kienb?ck disease.Long-term follow-up.J Bone Joint Surg (Am),2001,83-A(2):177-183.
14.	宮旭,王克利,路來金.晚期月骨無菌性壞死舟骨環形征的解剖學及生物力學研究.中國修復重建外科雜志,2004,18(5):356-359.
15.	Short WH,Werner FW,Fortino MD,et al.A dynamic biomechanical study of scapholunate ligament sectioning.J Hand Surg (Am),1995,20(6):986-999.
16.	Jia XY,Gong X,Lu LJ.Contact pressures in radiocarpal and triquetrohamate joints after vascularized capitate transposition.Ann Plast Surg,2011,67(5):534-538.
17.	路來金,孫玉霞,姜永沖,等.帶血管蒂頭狀骨移位替代月骨的應用解剖.中國臨床解剖學雜志,1997,15(4):261-264.
18.	趙云珍,潘志軍,楊樹清,等.帶掌側血管蒂部分頭狀骨移位替代壞死月骨的解剖學研究.中華手外科雜志,2012,28(4):198-201.

1. Canale ST.Kienbock's Disease//Canale ST.Campbell's Operative Orthopedics.Mosby:Science Press,1998:3469.
2. Lu L,Gong X,Liu Z,et al.Capitate transposition to replace necrotic lunate bone with a pedicle for Kienb?ck's disease:review of 30 cases.Chin Med J (Engl),2003,116(10):1519-1522.
3. Evans G,Burke FD,Barton NJ.A comparison of conservative treatment and silicone replacement arthroplasty in Kienb?ck's disease.J Hand Surg (Br),1986,11(1):98-102.
4. Stahelin A,Pfeiffer K,Sennwald G,et al.Determining carpal collapse.An improved method.J Bone Joint Surg (Am),1989,71(9):1400-1405.
5. Linscheid RL,Dobyns JH,Beabout JW,et al.Traumatic instability of the wrist.Diagnosis,classification,and pathomechanics.J Bone Joint Surg (Am),1972,54(8):1612-1632.
6. Armistead RB,Linscheid RL,Dobyns JH,et al.Ulnar lengthening in the treatment of Kienb?ck's disease.J Bone Joint Surg (Am),1982,64(2):170-178.
7. Gay AM,Parratte S,Glard Y,et al.Isolated capitate shortening osteotomy for the early stage of Kienb?ck disease with neutral ulnar variance.Plast Reconstr Surg,2009,124(2):560-566.
8. Hierner R,Wilhelm K.Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage Ⅲ lunate necrosis.Strategies Trauma Limb Reconstr,2010,5(1):23-29.
9. Sakai A,Toba N,Oshige T,et al.Kienb?ck disease treated by excisional arthroplasty with a palmaris longus tendon ball:a comparative study of cases with or without bone core.Hand Surg,2004,9(2):145-149.
10. Saffar P.Vascularized pisiform transfer in place of lunatum for Kienb?ck's disease.Chir Main,2010,29 Suppl 1:S112-S118.
11. 肖聰,劉國明,滕林,等.帶血管蒂豌豆骨瓣移位治療月骨缺血性壞死的中長期療效評估.中華骨科雜志,2011,31(3):238-242.
12. Lu LJ,Gong X,Wang KL.Vascularized capitate transposition for advanced Kienb?ck disease:application of 40 cases and their anatomy.Ann Plast Surg,2006,57(6):637-641.
13. Takase K,Imakiire A.Lunate excision,capitate osteotomy,and intercarpal arthrodesis for advanced Kienb?ck disease.Long-term follow-up.J Bone Joint Surg (Am),2001,83-A(2):177-183.
14. 宮旭,王克利,路來金.晚期月骨無菌性壞死舟骨環形征的解剖學及生物力學研究.中國修復重建外科雜志,2004,18(5):356-359.
15. Short WH,Werner FW,Fortino MD,et al.A dynamic biomechanical study of scapholunate ligament sectioning.J Hand Surg (Am),1995,20(6):986-999.
16. Jia XY,Gong X,Lu LJ.Contact pressures in radiocarpal and triquetrohamate joints after vascularized capitate transposition.Ann Plast Surg,2011,67(5):534-538.
17. 路來金,孫玉霞,姜永沖,等.帶血管蒂頭狀骨移位替代月骨的應用解剖.中國臨床解剖學雜志,1997,15(4):261-264.
18. 趙云珍,潘志軍,楊樹清,等.帶掌側血管蒂部分頭狀骨移位替代壞死月骨的解剖學研究.中華手外科雜志,2012,28(4):198-201.

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LONG-TERM EFFECTIVENESS OF VASCULARIZED CAPITATE OSTEOTOMY TRANSPOSITION FOR ADVANCED Kienb?ck's DISEASE

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