Iranian Journal of Orthopaedic Surgery Vol 10, No 2 (Serial No 39), Spring 2012:59-66 اﻳﺮان ﻣﻔﺎﺻﻞ و اﺳﺘﺨﻮان ﺟﺮاﺣﻲ ﻣﺠﻠﻪ دوره دﻫﻢ ﺷﻤﺎره، 2 ) ﻣﺴﻠﺴﻞ ﺷﻤﺎره39 ( ، ﺑﻬﺎر1391 ﺻﻔﺤﻪ، ﻫﺎي66 - 59 ﻃﻮﻻﻧﻲ ﺑﺮرﺳﻲ ﻛﻮﺗﺎه ﺟﺮاﺣﻲ ﺷﻴﻮه دو ﻣﺪت رادﻳﻮس ﻛﺮدن و اﺳﺘ ﭘﻴﻮﻧﺪ ﺧﻮن رگ ﺑﻪ ﻣﺘﺼﻞ ﺨﻮان رﺳﺎن ﺑﺎخ ﻛﻴﻦ ﺑﻴﻤﺎري در * اﻓﺸﺎ اﺣﻤﺪرﺿﺎ دﻛﺘﺮ ر، ** آﺗﺶ ﻋﻴﻮﺿﻲ ﻛﺮﻳﻢ دﻛﺘﺮ ﺑﻴ ﻚ » ﭘﺰﺷﻜﻲ ﻋﻠﻮم داﻧﺸﮕﺎه اروﻣﻴﻪ« ﺧﻼﺻﻪ ﭘﻴﺶ زﻣﻴﻨﻪ: اﻳﻦ در ﻣﻄﺎﻟﻌﻪ ﻃﻮﻻﻧﻲ ﻧﺘﺎﻳﺞ ﻣﺪت) از ﺑﻴﺶ5 ﺳﺎل( روش دو» ﻛﻮﺗ ﺎه رادﻳﻮس ﻛﺮدن« و» اﺳﺘﺨﻮان ﭘﻴﻮﻧﺪ ﺑﻪ ﻣﺘﺼﻞ ﺧﻮن رﺳﺎن« ﺑﻴﻤﺎر در ان ﻛﻴﻦ ﺑﺎخ ﺷﺪﻧﺪ ﻣﻘﺎﺑﺴﻪ. روش و ﻣﻮاد ﻫﺎ: در ﻣﻄﺎﻟﻌﻪ ﻳﻚ ﮔﺬﺷﺘﻪ ﻧﮕﺮ ﺑﺎ16 ﺑﻪ ﻣﺒﺘﻼ ﺑﻴﻤﺎر ﻣﺮاﺣﻞ اوﻟﻴﻪ ﺑﻴﻤﺎري ﻛﻴﻦ ﺑﺎخ، 9 ﺑﻴﻤ ﺎ ر ﺑﺎ دو ر ه ﭘﻴﮕﻴﺮي4 / 6 ﺳﺎل ﻛﻪ ﺗﺤﺖ ﻛﻮﺗﺎه ﻛﺮدن رادﻳﻮس ﺑﻮد ﮔﺮﻓﺘﻪ ﻗﺮار) ﮔﺮوه1 ( و7 ﺑ ﻴﻤﺎر دوره ﺑﺎ ﭘﻴﮕﻴﺮي5 / 6 ﻛﻪ ﺳﺎل ﺗﺤﺖ ﺧﻮن رگ ﺑﻪ ﻣﺘﺼﻞ اﺳﺘﺨﻮان ﭘﻴﻮﻧﺪ رﺳﺎن ﺑﻮدﻧﺪ ﮔﺮﻓﺘﻪ ﻗﺮار) ﮔﺮوه2 ( ﺑ ﺮرﺳﻲ ﺷﺪﻧﺪ. ﮔﺮوه دو از ﻧﻈﺮ ﺳﻦ، ﺟﻨﺲ، ﺷﺪه ﻋﻤﻞ دﺳﺖ، ﻣﺮاﺣﻞ اوﻟﻴﻪ ﺗﻘﺴﻴﻢ ﻃﺒﻖ ﺑﻴﻤﺎري ﺑﻨﺪي» ﻟﻴﺘﻤﻦ« و ﻣﺪت ﭘﻴﮕﻴﺮي ﻣﺸﺎﺑﻪ ﺑﻮدﻧﺪ. ﮔﺮوه دو در اوﻟﻨﺎر وارﻳﺎﻧﺲ ﺑﺎرزي ﺗﻔﺎوت داﺷﺘﻨﺪ. آﺧﺮﻳﻦ در ﭘﻴﮕﻴﺮي ﺑﻴﻤﺎران ﻧﻈﺮ از درد، ﻣﭻ ﺣﺮﻛﺎت دﺳﺖ، ﻗﺪرت زدن ﭼﻨﮓ، ﺑﺮرﺳﻲ رادﻳﻮﻟﻮژﻳﻚ ﺑﺮآوردﻫﺎي و ﻛﺎرﻛﺮد ﻗﺪرت ﺷﺪﻧﺪ. ﺑﺎ ﻧﺘﺎﻳﺞ ﻣﻘﻴﺎس» ﻧﺎﻛﺎﻣﻮرا« ) Nakamura ( و» ﻛﻮﻧﻴﻲ« ) Cooney ( ﺷﺪﻧﺪ ارزﻳﺎﺑﻲ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺑﻴﻦ درد ﻧﻈﺮ از ﮔﺮوه دو، ﺣﺮﻛﺎت ﻣﭻ دﺳﺖ، ﻗﺪرت زدن ﭼﻨﮓ و ﺗﻐﻴﻴﺮات ﭘﺮ ﺗﻮﻧﮕﺎري ﻣﻌﻨﻲ ﺗﻔﺎوت دار ي ﻧﺪاﺷﺖ وﺟﻮد، ﻣﻴﺰان اﮔﺮﭼﻪ ﻗﺪرت ﭼﻨﮓ زدن ﮔﺮوه در2 ﺑﻮد ﺑﺎﻻﺗﺮ. ﮔﺮوه در اول، در7 ﺑﻴﻤﺎر ﻧﻤﺮه» ﻧﺎﻛﺎﻣﻮرا« و در5 ﻧﻤﺮه ﺑﻴﻤﺎر» ﻛﻮﻧﻴﻲ« رﺿﺎﻳﺖ ﺑﻮد ﺑﺨﺶ. ﻧﻤﺮه ﺑﻴﻤﺎران ﺗﻤﺎﻣﻲ ﮔﺮوه2 ﻣﻘﻴﺎس دو در رﺿﺎﻳﺖ ﺑﺨﺶ ﺑﻮد. ﻧﻤﺮات ﻣﻴﺎﻧﮕﻴﻦ ﺗﻔﺎوت» ﻛﻮﻧﻴ ﻲ« ﮔﺮوه دو ﻣﻌ ﻨﻲ ﺑﻮد دار. ﻣﭻ ﻋﻤﻜﺮد ﻧﻈﺮ از ﻧﻤﺮات ﻣﻴﺎﻧﮕﻴﻦ ﺑﻴﻦ دﺳﺖ،» ﻛﻮﻧﻴﻲ« ﻣﻌﻨﻲ ﺗﻔﺎوت ﮔﺮوه دو در دار داﺷﺖ وﺟﻮد. ﻧﻤﺮات ﻣﻴﺎﻧﮕﻴﻦ ﺗﻔﺎوت» ﻧﺎﻛﺎﻣﻮرا« ﻣﻌﻨﻲ ﮔﺮوه دو در ﻧﺒﻮد دار. ﻧﺘﻴﺠﻪ ﮔﻴﺮي: ﻫﺮ ﻃﻮﻻﻧﻲ ﻧﺘﺎﻳﺞ ﮔﺮوه دو ﻳﺎ رادﻳﻮﻟﻮژﻳﻚ ﺗﻔﺎوت و داﺷﺘﻨﺪ ﻣﻨﺎﺳﺒﻲ ﻣﺪت ﺑﺎﻟﻴﻨﻲ ﺷﻴﻮه دو ﺑﻴﻦ اﺳﺎﺳﻲ ﺟﺮاﺣﻲ ﻧﺸﺪ ﻳﺎﻓﺖ. واژه ﻛﻠﻴﺪي ﻫﺎي: ﻛﻴﻦ ﺑﺎخ ؛ ﭘﻴﻮﻧﺪ اﺳﺘﺨﻮاﻧﻲ رادﻳﻮس،، ا ﺳﺘﺌﻮﺗﻮﻣﻲ ﻣﻘﺎﻟﻪ درﻳﺎﻓﺖ: 1 ؛ ﭼﺎپ از ﻗﺒﻞ ﻣﺎه ﺑﺎزﻧﮕﺮي و اﺻﻼح ﻣﺮاﺣﻞ: 1 ؛ ﺑﺎر ﻣﻘﺎﻟﻪ ﭘﺬﻳﺮش: 15 ﭼﺎپ از ﻗﺒﻞ روز Long-Term Clinical and Radiological Outcomes of Radial Shortening Osteotomy and Vascularized Bone Graft in Kienbö ck Disease * Ahmadreza Afshar, MD; ** Karim Eivaziatashbeik, MD Abstract Background: This study evaluated the long-term (>5 y) outcomes of radial shortening osteotomy and vascularized bone graft in Kienböck disease patients. Methods: In a retrospective study of 16 patients with early stage Kienböck disease, 9 patients with average follow-up of 6.4 years had radial shortening osteotomy (group 1), and 7 with average follow-up of 6.5 years had pedicled vascularized bone graft (group 2). The 2 groups were similar in age, sex, operated side, initial Lichtman stage, and follow-up duration. There were significant differences in ulnar variance between the 2 groups. At the last follow-up, the patients were evaluated for pain, wrist motion, grip strength, functional status, and radiographic assessment. The overall results were evaluated by Cooney wrist function score and Nakamura scoring system for Kienböck disease. Results: The 2 groups had no significant difference in pain, motion, grip strength, and radiologic assessment; however, grip strength percentage was better in group 2. There was no significant difference between the radiographic changes of the 2 groups. In group I, 7 patients had satisfactory Nakamura scores, and 5 patients had satisfactory Cooney scores. All of the patients in group 2 had satisfactory Cooney and Nakamura scores. The difference in the mean Cooney wrist function score in the 2 groups was significant. The difference of Nakamura scores in the 2 groups was not significant. Conclusions: Both groups had reasonable long-term outcomes. We were unable to recognize a substantial clinical or radiological difference between the 2 surgical treatments in long-term outcome. Key words: Kienböck; Bone transplantion; Radius; Osteotomy Received: 1 month before printing ; Accepted: 15 days before printing *Orthopaedic Surgeon, Department of Orthopaedics, Urmia University of Medical Sciences, Urmia, IRAN. **Resident of Orthopaedic Surgery, Department of Orthopedics, Urmia University of Medical Sciences, Urmia, IRAN. Corresponding author: Ahmadreza Afshar, MD Imam Khomeini Hospital, Modaress Street, Ershad Boulevard, Urmia, 57157-81351, Urmia, Iran. e-mail: afshar_ah@yahoo.com This study has been registered at Urmia University of Medical Sciences, deputy of research, as a dissertation thesis with record number 1044-90/12/17. The article published in The Journal of Hand Surgery (Am),2013;38A:289-296. Copyright © by the American Society for Surgery of the Hand. All rights reserved. ﭘﮋوﻫﺸﻲ ﻣﻘﺎﻟﻪ Downloaded from ijos.ir at 16:17 +0330 on Sunday December 5th 2021