For The Study Of Tendon Group Packing For The Treatmentof Aseptic Necrosis Of Lunate Long-term Effect

Objective:In this study, a method of treating tendon group tamponade aseptic necrosis of the lunate to the radial side of the wrist extensor tendon group short gap filling after removal of necrotic lunate, dorsal approach through the wrist, surgery incision dorsal ligaments around the wrist, after both sides opened the extensor tendon was cut short carpi ulnar extensor tendon or radial side of half-half, removal of the lunate bone, fascia tendon group tamponade. Wrist dorsal approach, to avoid damage to the wrist major blood vessels, nerves, tendons sutured by corporations and palm dorsal lunate joint capsule, can effectively increase the tendon machine of the support force, reducing the lunate bone removal like to come down Shen problems such as carpal derangement, reduce and eliminate wrist pain. The authors believe that surgical procedures for the treatment of advanced aseptic necrosis of the lunate bone has a simple, less complications and effective advantage. Infestation wrist and create conditions for early functional exercises, avoid long-term fixed joints caused by joint stiffness, improve wrist function of purpose.。Methods:From2006October to2010October period aseptic necrosis of lunate bone46cases of hospitalized patients, are in line with the X-ray Lichtman staging standard Ⅲ, Ⅳ cases.46patients with stage Ⅲ, Ⅳ standard is divided into groups, respectively for lunate excision+short radial carpal extensor group packing, all groups were subjected to preoperative wrist joint function and postoperative long-term (3years after the operation) contrast function of wrist joint, wrist joint function was evaluated according to the "2000the Chinese Medical Association of Hand Surgery Institute of upper limb functional assessment standard", and evaluate it objectively, fairly to the operation. Operation treatment of46cases. Ⅲ group23cases, male18cases, female5cases, age20-40years old in12cases, age41～60years old in8cases, age61～75years old in3cases; IV group23cases, male15cases, female8cases, age20～40years old in9cases,41～60years old in12cases, age61～75years old in2cases. Compared with the index of the two groups in gender, age, disease duration, disease stage, no significant difference (P>0.05), with comparable.Results:Postoperative follow-up of36to72months, an average of54months. Ⅲ group of patients before surgery wrist palmar flexion and dorsiflexion mean amplitude was32.0°,30.0°, surgery three years troubles carpometacarpal song, the magnitude of the mean dorsiflexion was40.5°,47.5°, pre-surgery patients Ⅳ group carpometacarpal song, the magnitude of the mean dorsiflexion was22.5°,21.5°, surgery three years troubles carpometacarpal song, the magnitude of the mean dorsiflexion was29.5°,35.0°. For surgical cases of stage III group by group tamponade tendon surgery can significantly improve motor function in patients wrist for IV group of surgical cases, suffering from wrist motor function improved, but there is no set of surgical cases of III significant effect. Ⅲ group of former patients suffering from wrist surgery was21.73%excellent features, functionality wrist surgery three years troubles excellent rate78.26%, excellent rate has been significantly improved. For the first stage IV group of patients suffering from wrist surgery features excellent rate8.69%,3years troubles wrist surgery features excellent rate13.04%, excellent rate increased obvious. Description lunate bone removal tendon group tamponade avascular necrosis of the lunate late term efficacy in patients with stage III obviously, for the long-term efficacy in patients with stage IV raise obvious.。Conclusion:1, Due to tendon group after filling the void caused by the removal of the lunate bone has its anatomical basis, in line with biomechanical principles to ensure the stability and function of the wrist, the wrist is conducive to conducting stress is an effective treatment of advanced osteonecrosis month methods.2, Plug in the treatment group using tendon lunate avascular necrosis, can effectively alleviate wrist pain patients, improve grip strength, enhanced wrist activity, maintaining a normal wrist high, life skills and improve the quality of life in patients with lung, treatment effective method of bone necrosis in late May.3, Reducing the risk of wrist fixed time, is conducive to early exercise, avoiding voids months after removal of bone necrosis caused by stiff wrist function and ectopic ossification, efficacy has been effectively improved, so is the treatment of aseptic necrosis of the lunate III, iv best way of cases.4, Tendon group tamponade in patients with advanced aseptic necrosis of the lunate, simple operation, less blood supply to the wrist rest wrist damage, fewer complications, which can effectively delay or prevent the further development of aseptic necrosis of the lunate bone disease complications caused by the generally available to promote, aseptic necrosis of the lunate III, better methods of treatment of stage IV patients.