جستجوی مقالات مرتبط با کلیدواژه « بیماری کین باخ » در نشریات گروه « پزشکی »

Kienbock's disease is an enigmatic entity that causes wrist pain and disability in young adults. This study aimed to assess clinical and radiological outcomes radial shortening as its most common treatment.

In a retrospective research, the data of medical records of 100 patients with Kienbock's disease were studied. They included 66 men and 34 women with mean age of 28.9 ± 7.6 years, who treated using radial shortening surgery. The wrist indexes and Disabilities of the Arm, Shoulder, and Hand Score (Quick DASH) were calculated and analyzed.

60% of the patients were ulnar minus, 26% neutral, and 14% ulnar plus. Mean Quick DASH score was 11.34 ± 6.30 in patients in the Lichtman stages I and II, and 23.05 ± 10.40 in the Lichtman stage III. Delayed union after 5 months occurred in 3%, screw back out in 1%, and superficial infection in 1%. Mean duration of union was 16 weeks. Ulnar variance was the same amongst different Lichtman stages. At follow up, 29% had none, 39% mild, 23% moderate, 8% severe, and 1% extreme pain. Ulnar variance changed from -0.9 to +0.1. Bilateral involvement was noted in 4% and dominant arm involvement in 45%. In 26% of patients, radius was shortened less than 1 millimeter. No radiological progression or improvement occurred during follow up.

 After radial shortening surgery in Kienbock's disease, clinical improvement was commonly expected, even if the radius was not shortened to reach to neutral ulnar variance. This improvement was more obvious in patients in in the Lichtman stages I and II.</div>

This study presents the distribution of ulnar variance among Iranian patients with Kienbock’s disease and a control group of normal adults of Iranian population. We evaluated the relationship between ulnar negative variance and Kienbock’s disease in our patients. This study included two groups. In the first group، we، retrospectively، reviewed our orthopaedic department clinic charts in two hospitals in Urmia-Iran، and collected the distribution of ulnar variances in 60 patients with Kienbock’s disease. The second group comprised the distribution of ulnar variances in 400 standard wrist radiographies of normal adult population. Comparisons were made between the findings of the two groups. The mean ulnar variance of the Kienbock’s group was negative 1. 1±1. 7 and the mean ulnar variance of the general population was positive 0. 7±1. 5. The difference of the ulnar variance means was statistically significant (p<. 001). There were 38 (63%) ulnar negative، 16 (27%) neutral and 6 (10%) ulnar positive variance in the Kienbock’s group and preponderance of ulnar negative variance was statistically significant (p=. 027). There were 56 (14%) ulnar negative، 160 (40%) neutral and 184 (46%) ulnar positive variance in the control group and there was no correlation with age or sex. There was an association between ulnar negative variance and development of Kienbock’s disease in this study (p<. 001). The findings of this study support the hypothesis that there is an association between the ulnar negative variance and development of Kienbock’s disease.

Kienbock disease resulting from avascular necrosis of lunate bone leads to pain and disability in young active patients. Radial shortening is one of the treatment methods in this disease. In this study we evaluated the mid-term results of treatment of Kienbock using radial shortening. In a retrospective study 9 males and 6 females with Kienbock disease with average age of 28.6±9.37 years who had undergone radial shortening were examined in a teaching hospital in Tehran-Iran. There were 2 patients in stage II 5 in IIIa and 8 in step IIIb of Lichman’s class. In a mean follow-up of 5±2.44 years these 15 cases were evaluated for wrist motion and gap strength and also with quick-DASH score. The radiograph Stahl index and carpal height ratio were also assessed. Pain and range of motion improved and grip strength was favorable in 13 patients. Quick-DASH score was 8.5±.84 in patients with stage II 12.72±5.09 in stage IIIa and 27.57±18.87 in stage IIIb. Stahl index and carpal height ratio were the same in patients with stage II but significantly decreased in other patients. Kienbock disease progressed in 2 cases. Radial shortening can relief clinical symptoms even in stage III and IIIb of Kienback diseases although the disease X-ray show radiographic worsening.

There are many different methods of treatment for Kienbock's disease or avascular necrosis of the carpal lunate. We are reporting our experience with lunate excision, capitate osteotomy and inter capitate bone grafting. Eleven male patients with stage III lunatomalacia treated by lunate excision capitate osteotomy and intra-capitate bone grafting were assessed with a mean follow-up of 6 years (2-10 years). The cases were evaluated in terms of pain, function, grip power and return to pre-treatment activities. Pain decreased significantly in all but one case. Grip strength had returned to above 70% of the strength of the opposite hand in all but one patient. Capitate osteotomy and inter-capitate bone graft without intercarpal arthrodesis in Kienbock disease is a safe and reliable technique for stage III disease.

Kienbock's disease refers to lunate bone avasular necrosis and if untreated in stage I or II will lead to collapse and cause deformity of bone. If it progress to stage III or IV, the salvage of radiocarpal bone will be impossible and patients may need a problematic surgery. The goal of this study is to compare the surgical treatment results of radial shortening or ulnar lengthening method in stage II. Sampling was done in simple sampling method (20 patients) that had wrist pain and referred to clinic. The patients divided into two groups. In first group radial shortening and osteotomy and in second group ulnar lengthening and oseotomy were done. The cure of disease was evaluated as 1) no pain in rest, 2) in normal activity, 3) in severe activity, 4) signs of union in radiography. The results showed that radial shortening method 10 patients and in ulnar lengthening group patients had recovered that (P<0.05). Our findings show radial shortening method is preferred to ulnar lengthening in stage II and therefore this method is suggested