Acceso usuarios
Ezequiel Ernesto Zaidenberg, Pablo De Carli, Jorge G. Boretto, Agustín Donndorff, Verónica A. Alfie, Gerardo Luis Gallucci, Aldo Illaramendi
IntroducciónEl objetivo de este trabajo es analizar los resultados clínicos y radiológicos a largo plazo de una serie de pacientes con enfermedad de Kienböck en estadios II y IIIA de la clasificación de Lichtman, tratados mediante descompresión metafisaria del radio distal. Materiales y MétodosEste estudio retrospectivo y descriptivo incluyó a 23 pacientes con enfermedad de Kienböck (estadios II y IIIA de Lichtman) tratados mediante descompresión metafisaria del radio distal con al menos 10 años de seguimiento. Al final del seguimiento, los pacientes fueron evaluados para el rango de movimiento de muñeca, fuerza de puño, escala de Mayo modificada y el dolor, según la escala visual analógica (EVA). Se valoró radiográficamente según la clasificación de Lichtman y el índice de altura carpiana (IAC).ResultadosEl seguimiento promedio fue de 14 años (rango 10-19). Nueve eran mujeres y catorce varones. Quince fueron estadio IIIA y ocho estadio II. Basado en la escala de Mayo, los resultados fueron excelentes en 9 pacientes, buenos en 11 pacientes, moderados en 2 y pobres en un paciente. La EVA preoperatoria fue 7 (rango 6-10) y fue 1,1 (rango 0-6) en el seguimiento final. El arco de flexión/extensión promedio fue del 78% y la fuerza de puño del 81%. Según la clasificación de Lichtman se produjo progresión en 4 pacientes mientras que los otros 19 pacientes permanecieron en la misma etapa que en el preoperatorio. ConclusiónLa descompresión metafisaria del radio distal demostró resultados favorables a largo plazo para los estadios II y IIIA de la enfermedad de Kienböck. AbstractIntroduction: The purpose of this study is to analyze the long-term clinical and radiological results of a series of patients with early stages of Kienböck disease treated with radius core decompression.Methods: This retrospective study included 23 patients with Kienböck’s disease (Lichtman stage II and IIIA) who underwent distal radius metaphyseal core decompression, and were controlled for at least 10 years. At the last follow-up, wrist range of motion and grip strength using the modified Mayo wrist score and pain using the visual analogue scale were evaluated. Patients were also radiographically evaluated with the Lichtman classification and the modified carpal height ratio.Results: The mean follow-up period was 14 years (range 10-9). Nine patients were women and fourteen were men. Fifteen cases belonged to IIIA stage and 8 to II stage. Based on the modified Mayo wrist score, results were excellent in 9 patients, good in 11 patients, fair in 2 and poor in one patient. Preoperative pain score according to VAS was 7 (range 6-10) and 1.1 (range 0-6) at the final follow-up. Average flexion/extension arc was 78% and the grip strength was 81%. Radiographic disease progression according to Lichtman classification occurred in four wrists, while the remaining 19 patients remained without changes.Conclusion: Radius core decompression achieved long-term favorable results in the early stages of Kienböck disease.
BackgroundThe purpose of this study is to analyze the long-term clinical and radiological results of a series of patients with early stages of the Kienbock disease treated with radius core decompression.MethodsThis retrospective study included 23 patients with Kienböck’s disease (Lichtman stage II and IIIA) who underwent distal radius metaphyseal core decompression that were followed-up for at least 10 years. At the last follow-up, the patients were evaluated for wrist range of motion and grip strength. The overall results were evaluated by the modified Mayo wrist score and visual analogue scale pain score. We also compared the radiological changes between the preoperative and final follow-up in their Lichtman classification and the modified carpal height ratio. ResultsThe mean follow-up period was 13 years (range 10-18). Based on the modified Mayo Wrist Score, clinical results were excellent in 9 patients, good in 11 patients, fair in 2 and poor in one patient. The mean preoperative pain according to VAS was 7 (range 6-10) and was 1.1 (range 0-6) at the final follow-up. Compared with the opposite side, the average flexion/extension arc was 78% and the grip strength was 81%. Radiographic disease progression according to the Lichtman classification occurred in four wrists.ConclusionThis long-term follow-up study shows that radius core decompression is a valid alternative for the treatment of the early stages of the kienbock disease.
