tailieunhanh - Hoại tử xương

Kienböck của bệnh, hoặc hoại tử xương của hình mặt trăng, có thể dẫn đến mãn tính, đau cổ tay gây suy nhược. Các yếu tố bệnh nguyên bao gồm các biến mạch máu và xương kết hợp với chấn thương hoặc tải lặp đi lặp lại. Trong giai đoạn I Kienböck của bệnh, chụp X quang đồng bằng xuất hiện bình thường, | Kienbock s Disease Diagnosis and Treatment Christopher H. Allan MD Atul Joshi MD and David M. Lichtman MD Abstract Kienbock s disease or osteonecrosis of the lunate can lead to chronic debilitating wrist pain. Etiologic factors include vascular and skeletal variations combined with trauma or repetitive loading. In stage I Kienbock s disease plain radiographs appear normal and bone scintigraphy or magnetic resonance imaging is required for diagnosis. Initial treatment is nonoperative. In stage II sclerosis of the lunate compression fracture and or early collapse of the radial border of the lunate may appear. In stage IIIA there is more severe lunate collapse. Because the remainder of the carpus is still uninvolved treatment in stages II and IIIA involves attempts at revascularization of the lunate either directly with vascularized bone grafting or indirectly by unloading the lunate . Radial shortening in wrists with negative ulnar variance and capitate shortening or radial-wedge osteotomy in wrists with neutral or positive ulnar variance can be performed alone or with vascularized bone grafting. In stage IIIB palmar rotation of the scaphoid and proximal migration of the capitate occur and treatment addresses the carpal collapse. Surgical options include scaphotrapeziotrapezoid or scaphocapitate arthrodesis to correct scaphoid hyperflexion. In stage IV degenerative changes are present at the midcarpal joint the radiocarpal joint or both. Treatment options include proximal-row carpectomy and wrist arthrodesis. J Am Acad Orthop Surg 2001 9 128-136 In 1910 Robert Kienbock a Viennese radiologist reported a series of 16 cases of traumatic malacia of the Although others had described similar anatomic findings in cadaveric specimens Kienbock s was the first clinical report of osteonecrosis of the lunate. He provided radiographic evidence of isolated changes beginning in the proximal portion of the lunate and affecting the radiolunate articulation with other areas .