Background

One of most accepted principles for treating Kienböck's disease before wrist degeneration settles in is to decompress the lunate by an osteotomy. Several osteotomies have been proposed since 1935. However, they are based on biomechanical hypotheses that are sometimes conflicting: This study compares the decompression effect of radius transverse shortening, radius lateral closing and medial closing wedge osteotomies, capitate shortening – with and without hamate shortening – and a Camembert-type radius wedge osteotomy with and without ulnar head shortening according to Sennwald.

Methods

We built a 3D wrist model using finite elements that included the metacarpal, carpal and forearm bones. All wrist ligaments and Triangular Fibrocartilage Complex were incorporated in the simulation. Load was applied on the metacarpals with the forearm bones fixed. We then applied the different osteotomies to the model.

Findings

When load was applied to the wrist, the osteotomies that best unloaded the lunate were the capitate shortening osteotomy combined with hamate shortening and the Camembert osteotomy combined with ulna shortening; the latter was the only osteotomy that completely unloaded the lunate.

Interpretation

We think the association of the radius Camembert osteotomy and ulna Sennwald's shortening osteotomy is the most effective procedure to propose in Kienböck's disease.

中文翻译：

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用于治疗Kienböck病的不同截骨术后的月牙负荷：3D有限元分析。

背景

在腕关节退化解决之前，治疗肯博克病的最普遍接受的原则之一是通过截骨术对月牙进行减压。自1935年以来，已经提出了几种截骨术。但是，它们是基于有时相互矛盾的生物力学假设：这项研究比较了transverse骨横向切开，radius骨外侧闭合和内侧闭合楔形截骨术，头状头缩短（有无无短缩）的减压效果。根据Sennwald的说法，采用卡门培尔特式wedge骨截骨术，并可以缩短和不缩短尺骨。

方法

我们使用有限的元素（包括掌骨，腕骨和前臂骨）构建了3D手腕模型。所有腕部韧带和三角纤维软骨复合体均纳入模拟。在前臂固定的情况下，对掌骨施加载荷。然后，我们将不同的截骨方法应用于模型。

发现

当对腕部施加负荷时，最能减轻月牙负荷的截骨术是：头状缩短截骨术与短椎体截骨术结合；卡门贝特截骨术与尺骨假体联合术。后者是唯一可以完全释放月牙的截骨术。

解释

我们认为Ca骨卡门培尔截骨术与尺骨Sennwald缩短截骨术的结合是肯尼伯氏病最有效的治疗方法。