نتایج درمانی کوتاه‌سازی رادیوس در بیماران کین‌باخ طی سال‌های 1390 تا 1395 در بیمارستان شفایحیاییان تهران

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 فلوشیپ، گروه ارتوپدی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران

2 دانشیار، گروه ارتوپدی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران

3 استادیار، گروه ارتوپدی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران

4 استاد، گروه ارتوپدی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران

چکیده

مقدمه: بیماری ابهام‌آمیز کین‌باخ، در افراد جوان باعث درد و ناتوانی مچ دست می‌شود. هدف از اجرای این مطالعه، ارزیابی نتایج کوتاه‌سازی استخوان رادیوس در این بیماران، از نظر بالینی و رادیولوژیک بود.روش‌ها: در یک مطالعه‌ی گذشته‌نگر، داده‌های پرونده‌ی 100 بیمار با سابقه‌ی کین‌باخ، مورد بررسی قرار گرفت. این افراد، شامل 66 مرد و 34 زن با میانگین سنی 6/7 ± 9/28 سال بودند که به روش جراحی کوتاه کردن رادیوس درمان شدند. اندکس‌های مچ و پرسش‌نامه‌ی Disabilities of the arm, shoulder and hand score (Quick DASH) برای کلیه‌ی این افراد محاسبه و تکمیل گردید.یافته‌ها: بیماران 60 درصد اولنار مینوس، 26 درصد نوتر و 14 درصد اولنار پلاس بودند. متوسط امتیاز کسب شده از پرسش‌نامه‌ی Quick DASH برای مرحله‌ی اول و دوم Lichtman 30/6 ± 34/11 و برای مرحله‌ی سوم Lichtman 40/10 ± 05/23 بود. در 3 درصد بیماران، تأخیر جوش خوردن بیش از 5 ماه و در 1 درصد بیرون زدگی پیچ از استخوان پیدا شد و یک مورد عفونت سطحی به وجود آمده بود. متوسط زمان تا یونیون 16 هفته بود. واریانس اولنا در گروه‌های مختلف Lichtman مشابه بود. از نظر درد بعد از عمل، 29 درصد بدون درد، 39 درصد درد خفیف، 23 درصد درد متوسط، 8 درصد درد شدید و 1 درصد درد بسیار شدید داشتند. اولنار واریانس از متوسط 9/0- به 1/0+ رسید. 4 درصد درگیری دوطرفه و 45 درصد درگیری دست غالب داشتند و بعد از عمل، در 26 درصد رادیوس کمتر از 1 میلی‌متر کوتاه شده بود. در طول مدت پی‌گیری بیماران در هیچ یک از بیماران پیشرفت رادیولوژی دیده نشد.نتیجه‌گیری: در بیماری کین‌باخ بعد از عمل کوتاه‌سازی رادیوس، حتی در مواردی که رادیوس تا رسیدن به اولنار واریانس نوتر کوتاه نشده بود، درد بیماران بهبود یافت. این بهبود در مراحل اول و دوم بیماری چشم‌گیرتر بود.

کلیدواژه‌ها

عنوان مقاله [English]

The Outcomes of Radial Shortening Treatment in Kienbock's Disease in Shafa Hospital, Tehran, Iran, during the Years 2011 and 2016

نویسندگان [English]

  • Bahman Hosseini 1
  • Farid Najd-Mazhar 2
  • Hooman Shariatzadeh 3
  • Davod Jafari 4
1 Fellowship, Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
2 Associate Professor, Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
3 Assistant Professor, Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
4 Professor, Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
چکیده [English]

Background: 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.Methods: 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.Findings: 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.Conclusion: 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.

کلیدواژه‌ها [English]

  • Kienbock's disease
  • Osteotomy
  • Radius
  • Wrist
  • Orthopedic surgery

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مجله دانشکده پزشکی اصفهان
دوره 37، شماره 533 - شماره پیاپی 533
مرداد و شهریور 1398
صفحه 775-783

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سابقه مقاله

  • تاریخ دریافت: 03 خرداد 1398
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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