LEVENT KÜÇÜK, Oğuz ÖZDEM, Erhan COŞKUNOL, S. Tahir SÜĞÜN, Kemal ÖZAKSAR

Evre 3 Kienböck hastalığında palmaris longus tendonuyla uygulanan eksizyonel artroplastinin karpal yükseklik oranına etkisi

Amaç: Tarif edilmesinin üzerinden yüzyıl geçmiş olmasına rağmen Kienböck hastalığının tedavi yöntemleriyle ilgili tartışmalar devam etmektedir. Günümüzde, lunatumun eksizyoııu ve oluşan boşluğun palmaris longus tendon yumağı ile doldurulması en sık uygulanan yöntemlerden biridir. Çalışmamızda, lunatumun çıkarılması ve otojen palmaris longus tendon grefti uygulanmış olan otuzsekiz hastanın uzun dönem sonuçlarının yanı sıra yapılan işlemin karpal yüksekliğe etkisini değerlendirdik. Çalışına planı: Evre 3 Kienböck hastalığı teşhisi ile 1978-2008 yılları arasında lunatum eksiz-yonu ve palmaris longus tendon yumağı ile boşluk doldurulması uygulanmış olan 38 hasta (ortalama yaş 30.4; dağılım: 17-64) geriye dönük olarak değerlendirildi. Ameliyat öncesi 8 hasta Lichtman Evre 3a, 30 hasta Evre 3b olarak sınıflandırıldı. Ameliyat sonrası ortalama takip süresi ise 81.3 (dağılım: 25-264) ay idi. Sonuçlar eklem hareket açıklığı, kavrama gücü ve Nakamu-ra fonksiyonel değerlendirmesi ve radyografik karpal yükseklik değişikliği ile değerlendirildi. Bulgular: Nakamura değerlendirme sistemine göre 22 hastada (%57.9) çok iyi. 13 hastada (%34.2) iyi, 3 hastada (%7.9) orta sonuç elde edildi. Ameliyat öncesi ve sonrası el bileği hareket genişlikleri karşılaştırıldığında el bileği ekstansiyonunda ortalama 10 derecelik artış (p

The effect of excisional arthroplasty with palmaris longus tendon on carpal height ratio in Stage 3 Kienböck’s disease

Objective: Treatment methods in Kienböck’s disease remain controversial despite the long-term awareness of the disease by orthopedic surgeons. Currently, excisional arthroplasty with a palmaris longus tendon ball is one of the most frequently used treatment methods. The aim of this study was to evaluate the long-term results of thirty-eight patients who had been treated with excisional arthroplasty and palmaris longus tendon ball, as well as the effect of this method on carpal height. Methods: In this study, we retrospectively evaluated 38 patients (mean age: 30.4 years; range: 17-64 years) with Stage 3 Kienböck’s disease who underwent excisional arthroplasty between 1978 and 2008. According to the Lichtman classification, 8 patients were classified as Stage 3a and 30 patients were classified as Stage 3b in Kienböck’s disease. The mean duration of followup after surgery was 81.3 (range: 25 to 264) months. The outcomes were evaluated with joint range of motion, grip strength and functional assessment of Nakamura and radiographic changes in carpal height. Results: According to the Nakamura's scoring system the results were excellent in 22 (57.9%) patients, good in 13 (34.2%) and moderate in 3 (7.9%). Comparison of pre- and postoperative range of motion of the wrist revealed an average increase in wrist extension of 10° (p<0.05), and an average decrease in ulnar deviation of 4° (p<0.05) after the operation. No significant difference was observed when comparing other joint range of motion parameters. Dynamometric grip strength measurements revealed significant differences between the healthy and operated sides (67.6 kgf vs. 45.9 kgf, respectively; p<0.05). The decrease in the revised carpal height ratio were significant. Conclusion: According to patient satisfaction rate and clinical results, the outcome of excisional arthroplasty with palmaris longus tendon ball in Stage 3 Kienböck’s disease is satisfactory. However, carpal height reduction and development of degenerative changes may be expected in long-term follow-up.

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