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Arch Hand Microsurg > Volume 20(1); 2011 > Article
Journal of the Korean Society for Surgery of the Hand 2011;20(1):43-50.
Published online May 31, 2011.
DOI: https://doi.org/10.12790/jkssh.2011.20.1.43   
The Treatment for Kienbock's Disease using the Fourth Extensor Compartment Artery Vascularized Bone Graft: Preliminary Results
Soo-Hwan Kang, MD, Hyoung-Min Kim, MD, Changhoon Jeong, MD, Sang-Uk Lee, MD, Kang-Wook Lee, MD, Il-Jung Park, MD
Department of Orthopaedic Surgery, The Catholic University of Korea, Seoul, Korea. jikocmc@naver.com
제 4 신전구획동맥 혈관부착 골 이식술을 이용한 키엔벡 질환의 치료: 예비 결과
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Abstract
  Lunate revascularization with the vascularized bone grafts is a current concept in the treatment of Kienbo¨ck disease. The aim of this study is to present our experience and preliminary results of the treatment using the fourth extensor compartment artery (4 ECA) vascularized bone graft for Kienbo¨ck disease.
Between May 2009 and June 2010, five patients (3 men and 2 women) with Kienbo¨ck disease were treated with 4 ECA vascularized bone grafts. The mean age was 32.8 years and mean follow-up time was 13 months. The patients were composed of two patients in stage II and three patients in stage IIIa according to Lichtman’s classification. Modified Mayo wrist score including pain, grip strength, range of motion and functional status and radiographic parameters such as carpal height ratio and radioscaphoid angle were evaluated at a final follow-up.
Pain was markedly diminished and modified Mayo wrist score was 82 at last follow up period. There were no or little changes in carpal height ratio and radioscaphoid angle. All patients showed satisfactory bony union and no further lunate collapse on follow-up radiographs.
The 4 ECA vascularized bone graft is a reliable alternative procedures among revascularization procedures for treatment of Kienbo¨ck’s disease. It is less invasive and has low risk of kinking of pedicle compared to the 4+5 ECA vascularized bone graft. However, long term follow-up and MRI evaluation at follow up period should be needed for the future.
Key Words: Lunate, Revascularization, Vascularized bone graft, Fourth extensor compartment artery, Kienbo¨ck disease
 


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