Results of Vascularized Bone Graft Application in The Kienböck Disease

Öz

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

Anahtar Kelimeler

• Lunate
• Kienböck’s Disease
• Bone Graft

Kienböck Hastalığında Vaskülarize Kemik Grefti Uygulamasının Sonuçları

Öz

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.

Anahtar Kelimeler

• Lunate
• Kienböck hastalığı, Kemik grefti,

Kaynakça

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