| Pronator Quadratus Muscle Pedicled Bone Graft in Kienböck’s Disease |
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Duke Whan Chung, Jae Hoon Lee |
| Kienböck씨 병에서 시행한 방형회내근 유경 골이식술 |
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정덕환, 이재훈 |
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| Abstract |
Purpose
s : Treatments of Kienböck’s disease range from conservative measures to various surgical procedures according to the progression of diseases. We reviewed and analysed the patients treated with pronator quadratus muscle pedicled (PQMP) bone graft for Kienbock’s disease and report the results of this procedure. Materials and Methods : 12 cases were treated with PQMP bone graft. The mean follow up period were 4 (1.2~11.3) years. Of the 12 patients, 9 were men and 3 women, with mean age of 39.5 (19~55) years. 2 patients had history of trauma, and 9 involvements occurred in the dominant hand. The author assessed subjective pain, radiographic finding such as Lichtman’s stage and carpal height ratio on the preoperative, postoperative, and last follow up, and analyzed range of motion of wrist, grip and pinch power measured by Jamar Dynamometer compared to opposite side. In the preoperative radiologic stages by Lichtman, 5 patients had stage II and 7 patients stage IIIA. Average carpal height ratio was 0.53 (0.51~0.55) preoperatively. Results : All patients had painless wrist and expressed satisfaction with the outcome of this procedure. All patients returned to their original jobs or avocations. 2 of 12 patients said that they had daily problems in the working but no problems in the activity of daily living. At the last follow up, the radiologic stages were as follows: stage II, 4 cases; stage IIIA, 7 cases; stage IIIB, 1 case. In the radiologic stages, 2 cases were deteriorated at last follow up. The mean carpal height ratio was 0.53 preoperatively and 0.52 (0.45~0.55) postoperatively. The average range of wrist motion, compared with that before operation, was increased slightly in all planes. The average palmar flexion was 52 degrees, an average increase of 9 degrees compared with the average preoperative palmar flexion; average dorsiflexion, 51 degrees, an average increase of 8 degrees; average ulnar deviation, 31 degrees, an average increase of 9 degrees; and radial deviation, 15 degrees, an average increase of 4 degrees. The average grip and pinch strength on the affected side were 79 % and 85% of that on the opposite side, an average improvement of 32% and 33%. Conclusion : PQMP bone graft is an effective treatment for Kienböck’s disease with stage II or IIIA in wrists, because pain relief, preserving range of motion of wrist with short period of immobilization, and preventing the progression of this disease can be expected. |
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