Kienböck hastalığı tedavisinde sınırlı karpal füzyonların yük aktarma özelliklerinin biyomekanik analizi
Amaç: Kienböck hastalığı tedavisinde kullanılan sınırlı karpal füzyonların lunatum üzerindeki yükü azaltarak etki ettikleri düşünülmesine karşın, biyomekanik çalışmalar kapitohamat füzyonunda lunatum yükünün arttığını göstermektedir. Bu deneysel çalışma bu çelişkiyi aydınlatmak amacıyla planlandı. Çalışma planı: Bu biyomekanik çalışmada, beş taze kadavra el bileğinde, 140 ve 210 newtonluk (N) yüklenmeler altında sağlam eklemlerle ve sınırlı karpal füzyonlarda (skafotrapeziotrapezoid, skafokapitat, kapitohamat) nötral, radial ve ulnar deviyasyonda yük dağılımları incelendi. Sonuçlar: Yüklenme 140 N iken, skafotrapeziotrapezoid ve skafokapitat füzyon sonrasında her pozisyonda lunatuma gelen yüklerde azalma, kapitohamat füzyon sonrasında artış görüldü. Yüklenme 210 N’ye çıkarıldığında, yüklerin dağılımı sağlam el bileğinde elde edilen değerlerden farklı değildi. Her iki yüklenme altında da, ulnar deviyasyonda iken lunatumun anlamlı derecede daha fazla yük altında kaldığı görüldü. Çıkarımlar: Bu sonuçlar, 210 N’lik yüklenme altında, sı- nırlı karpal füzyonların el bileğindeki yük dağılımını de- ğiştirmediğini göstermektedir. Kienböck hastalığı etyolojisinde ulnar deviyasyon yüklenmesi olduğu ve sınırlı karpal füzyonların el bileği yüklenme özelliklerini değiştirerek değil, ulnar deviyasyonu kısıtlayarak etki ettiği düşünülebilir.
Biomechanical analysis of load transmission characteristics of limited carpal fusions used to treat Kienböck's disease
Objectives: Although limited carpal fusions used in the treatment of Kienböck’s disease are thought to act by decreasing the loads on the lunate, biomechanical studies show that capitohamate fusion acts oppositely to what is expected. This experimental study was designed to resolve this paradox, Methods: In a biomechanical cadaveric study, load transmissions at the radioulnacarpal joint were investigated under 140 and 210 newtons of load with three wrist postures, namely, neutral, ulnar and radial deviations, in five intact wrists and after scaphotrapeziotrapezoid, capitohamate, and scaphocapitate fusions. Results: Under 140 newtons of load, the loads imposed to the lunate decreased following scaphotrapeziotrapezoid and scaphocapitate fusions, but increased after capitohamate fusion. However, when the load was increased to 210 newtons, there were no differences between intact wrists and limited carpal fusions in respect to the loads exerted on the lunate. In all the situations, the lunate was subjected to a significantly greater load in ulnar deviation. Conclusion: These results suggest that limited carpal fusions do not alter load transmission characteristics of the wrist joint under 210 newtons of load. The etiology of the Kienböck’s disease seems to be related to an overload in ulnar deviation and the beneficial effect of limited carpal fusions seems to be associated with restricted ulnar deviation of the wrist rather than load transmission characteristics.
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- 1. Allan CH, Joshi A, Lichtman DM. Kienbock’s disease: diagnosis and treatment. J Am Acad Orthop Surg 2001;9:128-36.
- 2. Werner FW, Palmer AK. Biomechanical evaluation of operative procedures to treat Kienbock’s disease. Hand Clin 1993; 9:431-43.
- 3. Armistead RB, Linscheid RL, Dobyns JH, Beckenbaugh RD. Ulnar lengthening in the treatment of Kienbock’s disease. J Bone Joint Surg [Am] 1982;64:170-8.
- 4. Inoue G. Capitate-hamate fusion for Kienbock’s disease. Good results in 8 cases followed for 3 years. Acta Orthop Scand 1992;63:560-2.
- 5. Sauerbier M, Trankle M, Erdmann D, Menke H, Germann G. Functional outcome with scaphotrapeziotrapezoid arthrodesis in the treatment of Kienbock’s disease stage III. Ann Plast Surg 2000;44:618-25.
- 6. Sennwald GR, Ufenast H. Scaphocapitate arthrodesis for the treatment of Kienbock’s disease. J Hand Surg [Am] 1995;20:506-10.
- 7. Short WH, Werner FW, Fortino MD, Palmer AK. Distribution of pressures and forces on the wrist after simulated intercarpal fusion and Kienbock’s disease. J Hand Surg [Am] 1992;17:443-9.
- 8. Horii E, Garcia-Elias M, Bishop AT, Cooney WP, Linscheid RL, Chao EY, et al. Effect on force transmission across the carpus in procedures used to treat Kienbock’s disease. J Hand Surg [Am] 1990;15:393-400.
- 9. Hara T, Horii E, An KN, Cooney WP, Linscheid RL, Chao EY, et al. Force distribution across wrist joint: application of pressure- sensitive conductive rubber. J Hand Surg [Am] 1992;17:339-47.
- 10. Trumble T, Glisson RR, Seaber AV, Urbaniak JR. A biomechanical comparison of the methods for treating Kienbock’s disease. J Hand Surg [Am] 1986;11:88-93.
- 11. Genda E, Horii E. Theoretical stress analysis in wrist joint-- neutral position and functional position. J Hand Surg [Br] 2000;25:292-5.
- 12. Cooney WP III, Chao EY. Biomechanical analysis of static forces in the thumb during hand function. J Bone Joint Surg [Am] 1977;59:27-36.
- 13. Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987;(214):136-47.
- 14. Lamoreaux L, Hoffer MM. The effect of wrist deviation on grip and pinch strength. Clin Orthop Relat Res 1995;(314):152-5.
- 15. Douglas DP, Peimer CA, Koniuch MP. Motion of the wrist after simulated limited intercarpal arthrodeses. An experimental study. J Bone Joint Surg [Am] 1987;69:1413-8.
- 16. Nakamura R, Tsuge S, Watanabe K, Tsunoda K. Radial wedge osteotomy for Kienbock disease. J Bone Joint Surg [Am] 1991;73:1391-6.
- 17. Matsushita K, Firrell JC, Tsai TM. X-ray evaluation of radial shortening for Kienbock’s disease. J Hand Surg [Am] 1992;17:450-5.
- 18. Nakamura R, Horii E, Imaeda T. Excessive radial shortening in Kienbock’s disease. J Hand Surg [Br] 1990;15:46-8.
- 19. Unver B, Gocen Z, Sen A, Gunal I, Karatosun V. Normal ranges of ulnar and radial deviation with reference to ulnar variance. J Int Med Res 2004;32:337-40.