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Kienböck Hastalığında Vaskülarize Kemik Grefti Uygulamasının Sonuçları

Year 2020, Volume: 17 Issue: 3, 447 - 453, 25.12.2020

Abstract

Amaç: Ekstansör kompartmanlı arter pediküllü vaskülarize kemik grefti (VBG) ile tedavi edilen Kienböck hastalarının postoperatif klinik ve radyolojik sonuçlarını değerlendirmeyi amaçladık.
Materyal ve Metod: Bu çalışmada, Ocak 2011-Haziran 2015 tarihleri arasında Harran Üniversitesi Ortopedi ve Travmatoloji Anabilim Dalı'nda Kienböck hastalığı tanısı alan ve revaskülarizasyon (distal radiustan pediküllü VBG ile) yapılan ve en az bir postoperatif takibi bulunan 12 hasta çalışmaya dahil edildi. İzlem sırasında bu hastalara Görsel Analog Skala (VAS), Modifiye Mayo Bilek Skoru (MMWS) ve (Q-DASH) anketi ile klinik değerlendirme yapıldı.
Bulgular: Olguların 7'si kadın (% 58,3), 5'i erkek (% 41,7) idi. Ortalama yaş 27.83 idi. Olguların yedisi (% 58,3) sağda, 10'u (% 83,3) dominant bilekte idi. Dokuzunda (% 75) travma öyküsü bulunamadı. Ameliyat sonrası 11 (% 91,7) hastada MMWS sonucu iyi / mükemmeldi ve bu hastaların Q-DASH skoru 5-20 arasında idi. Dokuz (% 75) hastanın VAS skoru 2 veya daha düşüktü. Hem preoperatif hem de postoperatif değerlendirmede 9 (% 75) vakada negatif ulnar varyans ve 3 (% 25) vakada nötr ulnar varyans (pozitif ulnar varyans yok) belirledik. Postoperatif Stahl endeksinde önemli değişiklikler tespit edilmedi. Preoperatif fleksiyon ve ekstansiyon hareket açıklığı değerleri postoperatif ölçümlerde anlamlı olarak arttı (p <0.05). Preoperatif değerler ile karşılaştırıldığında postoperatif karpal yükseklik oranının anlamlı olarak azaldığı ve bilek kavrama gücünün anlamlı olarak arttığı belirlendi. 11 vakada postoperatif sintigrafi yapıldı. 10 vakada osteoblastik aktivite tespit edildi. MRG sonuçları 5 hastada revaskülarizasyon lehine bulgular göstermiştir.
Sonuç: Kienböck hastalığının tedavisi için pediküllü VBG kullanımı revaskülarizasyon sağlamada ve işlevselliği geri kazanmada çok başarılıdır. Sintigrafide 1 hasta dışında hepsinde revaskülarizasyon tespit edilirken, MRG’da 5 hastada ravaskülarizasyon bulguları saptandı. Cerrahi yaklaşıma göre çeşitlendirilmiş daha fazla sayıda hasta ile tedaviye özgü sonuçlar daha detaylı araştırılabilir. Bu tür araştırmalar, Kienböck hastalığının tedavisinde uygun seçeneklerin belirlenmesinde yardımcı olacaktır.

Supporting Institution

Harran üniversitesi

Project Number

74059997.050.01.04/132

Thanks

Bedri Caner KAYA'ya teşekkür ederim

References

  • 1. Koca K, Kürklü M, Özkan H, Kılıç C. Karpal instabiletelerin radyolojik değerlendirmesi. Totbid Dergisi. 2013;12(1):47-53.
  • 2. Özcanlı H, Yeter AB. Kienböck Hastalığı TOTBİD Dergisi 2010;9(1):35-40.
  • 3. Shayesteh Azar M, Shahab Kowsarian SA, Mohseni-Bandpe MA, Hadian A. Kienbock's Disease in a Child. Iran J Med Sci. 2011;36(2):133-5.
  • 4. Cross D, Matullo KS. Kienböck Disease. Orthopedic Clinics. 2014;45(1):141-52.
  • 5. Lluch A, Garcia-Elias M. Etiology of Kienböck Disease. Techniques in Hand & Upper Extremity Surgery. 2011;15(1):33-7.
  • 6. Lichtman DM, Pientka WF, 2nd, Bain GI. Kienböck Disease: Moving Forward. The Journal of hand surgery. 2016;41(5):630-8.
  • 7. Afshar A, Mehdizadeh M, Khalkhali H. Short-term clinical outcomes of radial shortening osteotomy and capitates shortening osteotomy in Kienböck disease. Archives of Bone and Joint Surgery. 2015;3(3):173.
  • 8. Salman Z, Ongel K, Gözen RC. Kienböck Hastalığı: olgu sunumu. Smyrna Tıp Dergisi 2012; 2(1-ek1):14-16.
  • 9. Bekler HI, Erdag Y, Gumustas SA, Pehlivanoglu G. The proposal and early results of capitate forage as a new treatment method for Kienböck's disease. Journal of hand and microsurgery. 2013;5(2):58-62.
  • 10. Horch RE, Unglaub F, Dragu A, Kneser U, Bach AD. Morbus Kienböck. Diagnostik und Therapie der Os-lunatum-Nekrose [Kienböck's disease. Diagnosis and therapy]. Chirurg. 2008;79(5):452-460. doi:10.1007/s00104-008-1468-z
  • 11. Salmon J, Stanley JK, Trail IA. Kienböck's disease: conservative management versus radial shortening. The Journal of bone and joint surgery British volume. 2000;82(6):820-3.
  • 12. Jorge-Mora A, Pretell-Mazzini J, Marti-Ciruelos R, Andres-Esteban EM, Curto de la Mano A. Distal radius definitive epiphysiodesis for management of Kienböck´s disease in skeletally immature patients. Int Orthop. 2012;36(10):2101-5.
  • 13. Irisarri C, Kalb K, Ribak S. Infantile and juvenile lunatomalacia. Journal of Hand Surgery (European Volume). 2010;35(7):544-8.
  • 14. Elhassan BT, Shin AY. Vascularized bone grafting for treatment of Kienböck's disease. The Journal of hand surgery. 2009;34(1):146-54.
  • 15. Daecke W, Lorenz S, Wieloch P, Jung M, Martini AK. Vascularized os pisiform for reinforcement of the lunate in Kienböck's Disease: an average of 12 years of follow-up study. The Journal of hand surgery. 2005;30(5):915-22.
  • 16. Mathoulin C, Wahegaonkar AL. Revascularization of the lunate by a volar vascularized bone graft and an osteotomy of the radius in treatment of the Kienböck's disease. Microsurgery. 2009;29(5):373-8.
  • 17. Bochud RC, Büchler U. Kienböck's disease, early stage 3--height reconstruction and core revascularization of the lunate. Journal of hand surgery (Edinburgh, Scotland). 1994;19(4):466-78.
  • 18. Nakagawa M, Omokawa S, Kira T, Kawamura K, Tanaka Y. Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease. J Wrist Surg. 2016;5(2):98-104.
  • 19. Aspenberg P, Wang JS, Jonsson K, Hagert CG. Experimental osteonecrosis of the lunate. Revascularization may cause collapse. Journal of hand surgery (Edinburgh, Scotland). 1994;19(5):565-9.
  • 20. Kirkeby L, von Varfalva Palffy L, Hansen TB. Long-term results after vascularised bone graft as treatment of Kienböck disease. J Plast Surg Hand Surg. 2014;48(1):21-3.
  • 21. Fujiwara H, Oda R, Morisaki S, Ikoma K, Kubo T. Long-term results of vascularized bone graft for stage III Kienböck disease. The Journal of hand surgery. 2013;38(5):904-8.
  • 22. Afshar A, Eivaziatashbeik K. Long-term clinical and radiological outcomes of radial shortening osteotomy and vascularized bone graft in Kienböck disease. The Journal of hand surgery. 2013;38(2):289-96.
  • 23. Moran SL, Cooney WP, Berger RA, Bishop AT, Shin AY. The use of the 4 + 5 extensor compartmental vascularized bone graft for the treatment of Kienböck's disease. The Journal of hand surgery. 2005;30(1):50-8.
  • 24. Tsantes AG, Papadopoulos DV, Gelalis ID, Vekris MD, Pakos EE, Korompilias AV. The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients. Journal of hand and microsurgery. 2019;11(1):6-13.
  • 25. Park IJ, Kim HM, Lee JY, Roh YT, Kim DY, Jeon NH, et al. Treatment of Kienböck's disease using a fourth extensor compartmental artery as a vascularized pedicle bone graft. J Plast Reconstr Aesthet Surg. 2016;69(10):1403-10.
  • 26. Aydemir AN, Gönen M, Yorukoğlu A, Yücens M, Demirkan AF. The use of fourth extensor compartment artery bone flap in Kienböck's disease. Eklem Hastalik Cerrahisi. 2019;30(2):124-9.
  • 27. Geissler WB, Slade JF. Fractures of the carpal bones. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH(editors). Green’s Operative Hand Surgery. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2011. VOLUME .1 Part.3 Chapter 18 p:639-707.
  • 28. Jackson MD, Barry DT, Geiringer SR. Magnetic resonance imaging of avascular necrosis of the lunate. Archives of physical medicine and rehabilitation. 1990;71(7):510-3.
  • 29. Sowa DT, Holder LE, Patt PG, Weiland AJ. Application of magnetic resonance imaging to ischemic necrosis of the lunate. The Journal of hand surgery. 1989;14(6):1008-16.
  • 30. Citlak A, Akgun U, Bulut T, Tahta M, Dirim Mete B, Sener M. Partial capitate shortening for Kienböck's disease. J Hand Surg Eur Vol. 2015;40(9):957-60.
  • 31. Turan AC. Kienböck hastalığı tedavisinde kullanılan radial kısaltma osteotomisinin radioulnokarpal ekleme binen yükler üzerindeki etkilerinin araştırılması (Biyomekanik çalışma). Uzmanlık Tezi. Dokuz Eylül Üniversitesi. İzmir 2008.
  • 32. Sügün TS. Kienböck hastalığı tedavisi takip sonuçları. Uzmanlık Tezi. Ege Üniversitesi. İzmir. 2005.
  • 33. Aygün H, Atilla HA, Hapa O, Sanal HT. Ortopedik Radyolojide Sıkça Karşılaşılan Hatalı Veya Eksik Yorumlamalar: Neleri Görmek Gerekir? Neleri Göremiyoruz? Totbid Derisi 2013;12(1):13-27.
  • 34. Youm Y, McMurthy RY, Flatt AE, Gillespie TE. Kinematics of the wrist. I. An experimental study of radial-ulnar deviation and flexion-extension. The Journal of bone and joint surgery American volume. 1978;60(4):423-31.
  • 35. Cannon LD Wrist Disorders. In: Canale ST, Beaty JH.(editors) Campbell’s Operative Orthopaedics. Twelfth edition. Philadelphia, PA: Elsevier Mosby; 2013: volume:4 Chapter: 69. p. 3383-3476.
  • 36. Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scandinavian journal of pain. 2016;13:67-75.
  • 37. Koldas Dogan S, Ay S, Evcik D, Baser O. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clinical rheumatology. 2011;30(2):185-91.
  • 38. Meier R, van Griensven M, Krimmer H. Scaphotrapeziotrapezoid (STT)-arthrodesis in Kienbock's disease. Journal of hand surgery (Edinburgh, Scotland). 2004;29(6):580-4. 39. Gillis JA, Khouri JS, Moran SL. Adolescent Kienböck's Disease: A Comparison between Lunate Offloading and Revascularization Procedures. J Wrist Surg. 2020;9(3):197-202.

Results of Vascularized Bone Graft Application in The Kienböck Disease

Year 2020, Volume: 17 Issue: 3, 447 - 453, 25.12.2020

Abstract

Background: We aimed to evaluate the postoperative clinical and radiological results of Kienböck patients treated with extensor compartmental artery pedicled vascularized bone graft (VBG).
Materials and Methods: In this study, 12 patients who were diagnosed with Kienböck’s disease and underwent revascularization (with pedicled VBG from distal radius) and attended at least one postoperative follow-up between January 2011 and June 2015 in Harran University, Department of Orthopedics and Traumatology. In the follow-up, clinical evaluation was performed with Visual Analog Scale (VAS), Modified Mayo Wrist Score (MMWS) and Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH).
Results: Seven of the cases were female (58.3%) and 5 of them were male (41.7%). Mean age was 27.83. Seven (58.3%) of the cases were on the right, while 10 (83.3%) were on the dominant wrist. Trauma history was not found in 9 (75%) cases. After the operation, the MMWS result was good / excellent in 11 (91.7%) patients, and the Q-DASH score of these patients was between 5-20. Nine (75%) patients had a VAS score of 2 or lower. In both preoperative and postoperative evaluation, we determined negative ulnar variance in 9 (75%) and neutral ulnar variance in 3 (25%) cases (no positive ulnar variance). Significant changes in postoperative Stahl index were not determined. Preoperative flexion and extension range of motion values had increased significantly at postoperative measurements (p <0.05). When compared with the preoperative values, it was determined that postoperative carpal height ratio decreased significantly, and wrist grip strength increased significantly. Postoperative scintigraphy was performed in 11 cases. Osteoblastic activity was detected in 10 cases. The MRI results of these 10 cases showed findings in favor of revascularization in 5 patients.
Conclusions: The use of pedicled VBG for the treatment of Kienböck’s disease is very successful in providing revascularization and restoring functionality. Revascularization was detected in scintigraphy in all but 1 patient, while MRI showed it in 5 patients. Treatment-specific results can be explored in more detail with a higher number of patients diversified according to surgical approach. Such efforts will be helpful in determining appropriate options in the treatment of Kienböck's disease.

Key Words: Lunate, Kienböck’s Disease, Bone Graft

Project Number

74059997.050.01.04/132

References

  • 1. Koca K, Kürklü M, Özkan H, Kılıç C. Karpal instabiletelerin radyolojik değerlendirmesi. Totbid Dergisi. 2013;12(1):47-53.
  • 2. Özcanlı H, Yeter AB. Kienböck Hastalığı TOTBİD Dergisi 2010;9(1):35-40.
  • 3. Shayesteh Azar M, Shahab Kowsarian SA, Mohseni-Bandpe MA, Hadian A. Kienbock's Disease in a Child. Iran J Med Sci. 2011;36(2):133-5.
  • 4. Cross D, Matullo KS. Kienböck Disease. Orthopedic Clinics. 2014;45(1):141-52.
  • 5. Lluch A, Garcia-Elias M. Etiology of Kienböck Disease. Techniques in Hand & Upper Extremity Surgery. 2011;15(1):33-7.
  • 6. Lichtman DM, Pientka WF, 2nd, Bain GI. Kienböck Disease: Moving Forward. The Journal of hand surgery. 2016;41(5):630-8.
  • 7. Afshar A, Mehdizadeh M, Khalkhali H. Short-term clinical outcomes of radial shortening osteotomy and capitates shortening osteotomy in Kienböck disease. Archives of Bone and Joint Surgery. 2015;3(3):173.
  • 8. Salman Z, Ongel K, Gözen RC. Kienböck Hastalığı: olgu sunumu. Smyrna Tıp Dergisi 2012; 2(1-ek1):14-16.
  • 9. Bekler HI, Erdag Y, Gumustas SA, Pehlivanoglu G. The proposal and early results of capitate forage as a new treatment method for Kienböck's disease. Journal of hand and microsurgery. 2013;5(2):58-62.
  • 10. Horch RE, Unglaub F, Dragu A, Kneser U, Bach AD. Morbus Kienböck. Diagnostik und Therapie der Os-lunatum-Nekrose [Kienböck's disease. Diagnosis and therapy]. Chirurg. 2008;79(5):452-460. doi:10.1007/s00104-008-1468-z
  • 11. Salmon J, Stanley JK, Trail IA. Kienböck's disease: conservative management versus radial shortening. The Journal of bone and joint surgery British volume. 2000;82(6):820-3.
  • 12. Jorge-Mora A, Pretell-Mazzini J, Marti-Ciruelos R, Andres-Esteban EM, Curto de la Mano A. Distal radius definitive epiphysiodesis for management of Kienböck´s disease in skeletally immature patients. Int Orthop. 2012;36(10):2101-5.
  • 13. Irisarri C, Kalb K, Ribak S. Infantile and juvenile lunatomalacia. Journal of Hand Surgery (European Volume). 2010;35(7):544-8.
  • 14. Elhassan BT, Shin AY. Vascularized bone grafting for treatment of Kienböck's disease. The Journal of hand surgery. 2009;34(1):146-54.
  • 15. Daecke W, Lorenz S, Wieloch P, Jung M, Martini AK. Vascularized os pisiform for reinforcement of the lunate in Kienböck's Disease: an average of 12 years of follow-up study. The Journal of hand surgery. 2005;30(5):915-22.
  • 16. Mathoulin C, Wahegaonkar AL. Revascularization of the lunate by a volar vascularized bone graft and an osteotomy of the radius in treatment of the Kienböck's disease. Microsurgery. 2009;29(5):373-8.
  • 17. Bochud RC, Büchler U. Kienböck's disease, early stage 3--height reconstruction and core revascularization of the lunate. Journal of hand surgery (Edinburgh, Scotland). 1994;19(4):466-78.
  • 18. Nakagawa M, Omokawa S, Kira T, Kawamura K, Tanaka Y. Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease. J Wrist Surg. 2016;5(2):98-104.
  • 19. Aspenberg P, Wang JS, Jonsson K, Hagert CG. Experimental osteonecrosis of the lunate. Revascularization may cause collapse. Journal of hand surgery (Edinburgh, Scotland). 1994;19(5):565-9.
  • 20. Kirkeby L, von Varfalva Palffy L, Hansen TB. Long-term results after vascularised bone graft as treatment of Kienböck disease. J Plast Surg Hand Surg. 2014;48(1):21-3.
  • 21. Fujiwara H, Oda R, Morisaki S, Ikoma K, Kubo T. Long-term results of vascularized bone graft for stage III Kienböck disease. The Journal of hand surgery. 2013;38(5):904-8.
  • 22. Afshar A, Eivaziatashbeik K. Long-term clinical and radiological outcomes of radial shortening osteotomy and vascularized bone graft in Kienböck disease. The Journal of hand surgery. 2013;38(2):289-96.
  • 23. Moran SL, Cooney WP, Berger RA, Bishop AT, Shin AY. The use of the 4 + 5 extensor compartmental vascularized bone graft for the treatment of Kienböck's disease. The Journal of hand surgery. 2005;30(1):50-8.
  • 24. Tsantes AG, Papadopoulos DV, Gelalis ID, Vekris MD, Pakos EE, Korompilias AV. The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients. Journal of hand and microsurgery. 2019;11(1):6-13.
  • 25. Park IJ, Kim HM, Lee JY, Roh YT, Kim DY, Jeon NH, et al. Treatment of Kienböck's disease using a fourth extensor compartmental artery as a vascularized pedicle bone graft. J Plast Reconstr Aesthet Surg. 2016;69(10):1403-10.
  • 26. Aydemir AN, Gönen M, Yorukoğlu A, Yücens M, Demirkan AF. The use of fourth extensor compartment artery bone flap in Kienböck's disease. Eklem Hastalik Cerrahisi. 2019;30(2):124-9.
  • 27. Geissler WB, Slade JF. Fractures of the carpal bones. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH(editors). Green’s Operative Hand Surgery. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2011. VOLUME .1 Part.3 Chapter 18 p:639-707.
  • 28. Jackson MD, Barry DT, Geiringer SR. Magnetic resonance imaging of avascular necrosis of the lunate. Archives of physical medicine and rehabilitation. 1990;71(7):510-3.
  • 29. Sowa DT, Holder LE, Patt PG, Weiland AJ. Application of magnetic resonance imaging to ischemic necrosis of the lunate. The Journal of hand surgery. 1989;14(6):1008-16.
  • 30. Citlak A, Akgun U, Bulut T, Tahta M, Dirim Mete B, Sener M. Partial capitate shortening for Kienböck's disease. J Hand Surg Eur Vol. 2015;40(9):957-60.
  • 31. Turan AC. Kienböck hastalığı tedavisinde kullanılan radial kısaltma osteotomisinin radioulnokarpal ekleme binen yükler üzerindeki etkilerinin araştırılması (Biyomekanik çalışma). Uzmanlık Tezi. Dokuz Eylül Üniversitesi. İzmir 2008.
  • 32. Sügün TS. Kienböck hastalığı tedavisi takip sonuçları. Uzmanlık Tezi. Ege Üniversitesi. İzmir. 2005.
  • 33. Aygün H, Atilla HA, Hapa O, Sanal HT. Ortopedik Radyolojide Sıkça Karşılaşılan Hatalı Veya Eksik Yorumlamalar: Neleri Görmek Gerekir? Neleri Göremiyoruz? Totbid Derisi 2013;12(1):13-27.
  • 34. Youm Y, McMurthy RY, Flatt AE, Gillespie TE. Kinematics of the wrist. I. An experimental study of radial-ulnar deviation and flexion-extension. The Journal of bone and joint surgery American volume. 1978;60(4):423-31.
  • 35. Cannon LD Wrist Disorders. In: Canale ST, Beaty JH.(editors) Campbell’s Operative Orthopaedics. Twelfth edition. Philadelphia, PA: Elsevier Mosby; 2013: volume:4 Chapter: 69. p. 3383-3476.
  • 36. Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scandinavian journal of pain. 2016;13:67-75.
  • 37. Koldas Dogan S, Ay S, Evcik D, Baser O. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clinical rheumatology. 2011;30(2):185-91.
  • 38. Meier R, van Griensven M, Krimmer H. Scaphotrapeziotrapezoid (STT)-arthrodesis in Kienbock's disease. Journal of hand surgery (Edinburgh, Scotland). 2004;29(6):580-4. 39. Gillis JA, Khouri JS, Moran SL. Adolescent Kienböck's Disease: A Comparison between Lunate Offloading and Revascularization Procedures. J Wrist Surg. 2020;9(3):197-202.
There are 38 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Ali Levent 0000-0002-3666-1084

Serkan Sipahioğlu 0000-0001-5987-2813

Metin Yaptı 0000-0001-7461-8936

Mehmet Akif Altay 0000-0001-9164-6090

Baki Volkan Çetin 0000-0003-3231-404X

Project Number 74059997.050.01.04/132
Publication Date December 25, 2020
Submission Date November 24, 2020
Acceptance Date December 16, 2020
Published in Issue Year 2020 Volume: 17 Issue: 3

Cite

Vancouver Levent A, Sipahioğlu S, Yaptı M, Altay MA, Çetin BV. Results of Vascularized Bone Graft Application in The Kienböck Disease. Harran Üniversitesi Tıp Fakültesi Dergisi. 2020;17(3):447-53.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty