Free Stuff On The Lunate Bone Tendon After Removal Function Of The Wrist And Efficacy Analysis

Objective: Kienbock known as Kienbock disease occurs in young adults advantage wrist, the cause is still unknown, divided into internal and external factors, is a result of many factors, along with the development of modern imaging techniques, clinical diagnosis is clear, but the diversity of treatment options. According to the clinical stage, Kienbock feasible early conservative treatment, while a large number of literature reports, the majority of patients with advanced required by surgery, and surgical options range is divided into biology surgery, biomechanics surgery, lunate excision alone bone replacement surgery and months, proximal row of carpal resection and radiocarpal arthrodesis. Now more commonly used for treatment of advanced kienbock’disease is surgical removal of the lunate free tendon tamponade, often choose tendon tendon ball as the lunate bone substitute. But after filling can ensure the stability of the wrist and functional recovery, whether to change the wrist anatomical relationship will cause a new wrist trauma, has reported significant.So through the adoption effect on the stability and function of the wrist or take the free tendon packed follow-up clinical data, analysis and comparison discuss tendon after filling in the treatment late kienbock’disease. we consider the possibility of the two by comparing the treatment of advanced kienbock’disease of the procedure, and to provide a reference for the need for clinical work and the effect of tendon removed after resection offers a better choice for the treatment of aseptic necrosis of the lunate.Methods: Subjects: According to research needs to develop case selection criteria:(1)Based on patient history, physical examination, X-ray and CT imaging technology, patients diagnosed late kienbock’diease.(2)According to commonly used in clinical Lichtman stage, the disease belongs to Ⅲ, Ⅳ patients(3)No other central nervous system diseases or disorders of the wrist injury(4)No metabolic diseases, no wrist arthritis, wrist fracture and dislocation of history, surgical history of the patient(5)No effect of treatment of systemic diseases. We will review the Third Hospital of Hebei Medical University, choose kienbock’disease in patients with a total of 55 cases treated in 2005-2014 since the past nine years, including 10 cases of patients with early( phase Ⅰ,Ⅱ), not as the object of study. The kienbock’disease in patients with advanced screening criteria will be consistent with these 45 cases, a total of 45 side, all patients the right to inspect the dominant hand 40 cases, 5 cases left. Divided into two groups: simple line lunate excision 20 cases(20 sides). Research Group: tendon tamponade 25 cases(25 sides), with an average follow-up time after 6 months to 9 years, were measured in the preoperative and postoperative patients were revised carpal height ratio, revised carpal height index and upper extremity use dysfunction assessment Scale(PRWE) assess the quality of life of patients after surgery, the measured data were analyzed using statistical software SPSS21.0. The measured data were analyzed using statistical software SPSS21.0. Measurement data with χ—± S that the groups were compared using the t-test and Wilcoxon test.Result: 1 The general result:A total of 45 cases of 2 patients(45 sides), through patient follow-up, in which the traditional lines lunate excision 20 cases(20 sides) free tendon tamponade 25 cases(25 sides). The average hospital stay of 15 days, no incision infection, hematoma, skin edge necrosis, scar adhesions and other complications, with an average time of 12 days stitches, have reached a healing, none of the patients were followed up wrist dysfunction, deformity and pain increased, and all patients were followed up for clinical symptoms were improved in varying degrees, wrist flexion and extension activities close to normal levels. Wrist flexion and extension range of motion and limb grip strength increased significantly compared with the preoperative values, wrist median nerve Tinel sign(-). 2 Evaluation, Determination of revised carpal height ratio and revised carpal height index: 2.1 Evaluation: according to Cooney wrist score, traditional lunate excision alone group: excellent in 12 cases, good in 4 cases, 3 cases and poor in 1 case, good rate of 80%, tendon packing group: excellent in 20 cases, good in 3 cases, 2 cases, differential cases, good rate of 92%, excellent rate of surgery patients were not statistically significant(P> 0.05). 2.2 Determination of revised carpal height ratio and revised carpal height index: The study used revised carpal height ratio and revised carpal height index Nattran proposed as measured wrist standards,two groups of patients were measured revised carpal height ratio and revised carpal height index. Result of pre-operation in revised carpal height ratio: There was no significant difference among 2 groups Result of pre-operation in revised carpal height index: There was no significant difference among 2 groups(P>0.05) Result of postoperative in revised carpal height ratio: There was significant difference among 2 groups(P<0.05). Result of postoperative in revised carpal height index: There was significant difference among 2 groups(P<0.05). 3 Evaluation of PRWE score result: According to PRWE Mac Dermid raised(Patient-Rated Wrist Evaluation) wrist score, after two groups of patients PRWE scores were significant difference.(P <0.05).Conclusion:1 For patients of late Kienbock’disease undergoing the lunate removal free tendon tamponade is an effective surgical method.2 After removal of free lunate carpal tendon tamponade is effective, simple surgical procedure, less invasive, patient recovery time is short, inexpensive, can be used as late kienbock’disease preferred surgical patients.3 Packing tendon for carpal stability of a supporting role, to prevent disorder carpal order.