Clinical Study Of Arthroscopy-assisted Allogeneic Bone Graft Combined With A External Fixator For The Treatment Of Stage Ⅱ Kienb(?)ck Disease

Objective: On the theoretical basis of the combination of lunate bone internal and external load reduction and revascularization,we performed the arthroscopy-assisted allogeneic bone graft and a external fixator on Lichtman II patients.Through measurement and comparative analysis a series of objective and subjective index data such as modified wrist height rate,wrist height ratio and lunar bone CT value before and after surgery,to evaluate its effectiveness and safety,and provide a better choice for treatment of Kienbock disease.Method: we finally reviewed a total of 34 patients with stage II unilateral Kienbock disease who were admitted to the Third Hospital of Hebei Medical University from January 2014 to October 2018 in the past 5 years.The dominant hand in 32 cases was the right hand and 2 cases were left-handed.The average postoperative follow-up time was 31 months,ranging from 26 months to 57 months.The clinical and radiological indicators of the patients before and after the operation and the intraoperative arthroscopic performance were recorded.The clinical indicators include: visual analog scale,grip strength,angle of movement of the wrist,modified Mayo wrist score;radiological indicators include: modified wrist height ratio,Stahl index,scapholunate,radioscaphoid,and capitate lunate angles,CT value;intraoperative arthroscopic manifestations include: synovitis,periluninal ligament injury,Bain and Begg’s classfication.The measured data was analyzed using SPSS21.0 statistical software.The measurement data is represented by (?)±S,and the pre-and post-operative data comparison uses paired sample t test and rank sum test.Results:1.Intraoperative arthroscopy findingsAll patients had wrist synovitis,16 cases(47%)had a tear of the third or scapholunar ligament,and 26 cases(76%)had an irregular articular surface.2.Changes in clinical indicators and evaluation of efficacyThe patient’s VAS score improved from 5.8±0.7 to 0.9±0.5,grip strength increased from 56%±8% to 78%±6%,wrist flexion activity increased from43±8° to 57±6°,and back extension activity increased from 43±8° to 57±6°.39±5° increased to 51±6°,the difference was statistically significant(P<0.05).According to the modified Mayo wrist score,8 cases were excellent,18 cases were good,4 cases were fair,and 4 cases were poor.The excellent and good rate was 76.47%.3.Radiological indicatorsThe postoperative modified wrist height rate and Stahl index measurement results were not statistically different from those before the operation(P>0.05).CT showed that 33 cases(97%)of patients had allogeneic cancellous bone healing.The CT value increased from 430.36±185.79 HU before operation to 516.73±153.1 HU after operation,with a significant difference(P<0.05).4.General results and complicationsA total of 34 patients underwent arthroscopy-assisted allogeneic bone graft combined with a external fixator.Through outpatient follow-up,the average disease duration was 11 months,the average hospital time was 9 days,and the average return to work time was 3 months.During follow-up,a69-year-old male patient progressed to stage IIIA.He developed mild pain as the wrist was overactive.CT scan showed irregular stenosis of the radiocarpal joint and nonunion of allogeneic bone in this patient.However,his wrist flexion/extension move range reached 71/60°,and the patient was satisfied with the significant improvement in symptoms and did not seek further treatment.Two patients developed minor complications.One patient suffered from needle infection of the external fixator,which healed within 12 days after local dressing change and oral antibiotic treatment.The other patient developed irritation of sensory branches of the radial nerve near the needle tract of the external fixator,which completely relieved spontaneously after 4months.Conclusions:1.Arthroscopy-assisted allogeneic bone graft combined with a external fixator is a safe and effective surgical method for the treatment of stage II kienb(?)ck disease.2.Arthroscopically assisted lunate allogeneic bone implantation combined with external fixator resulted in less trauma and complete decompression,which could preserve the structural integrity and function of lunate bone to the maximum extent,but could not reverse the disease progression.3.CT value was more accurate than radiological index in determining the progress of Kienb(?)ck Disease.