Two Treatments ⅢB On Biomechanical Comparison Of Lunate Osteonecrosis In Operative Methods And Clinical Application Research

[Objective]1. By exploring and studying the etiology of aseptic lunate steonecrosis,making clear lunate osteonecrosis staging,as well as the different stages of treatments principle,adopting the production of Ⅰ-Scan pressure measurement system made by the most accurate Tekscan company in the united states,measuring ⅢB on biomechanical changes of lunate osteonecrosis in two operative methods,for the treatments of kienbocks disease to provide biomechanical basis。2. Based on the biomechanical test to choose better clinical application research of operation。the instrument itself and continuously improving the operation skills, in order to get better clinical curative effect.[Methods]1.18fresh upper limb specimens of adult patients were used, randomly divided into4groups, group A:normal wrist joint; Group B:STT fusion; Group C:the capitatenavicular arthrodesis. Adopt international advanced Ⅰ-scan pressure measurement system, put piezoelectric thin film between wrist radial navicular and radial clearance and connected it to the computer Ⅰ-scan system, loaded on the material testing system. The same testing procedures were repeated under every functional motion (neutral position,5°palmar flexion,30°dorsal extension,10°radial deviation,15°ulnar deviation). stretch a pressure forlON/s speed on wrist to100N, record dynamically and analyse each specimen radial navicular and radial pressure distribution between joint surface and pressure load and other related information;2. We treated16patients who was aseptic lunatenecrosis of Lichtman staging IIIB by doing STT arthrodesis using NT-STTAC. The mean follow up time was12months after surgery. The Follow-up content included grip strength, range of the wrist,wrist pain and X-ray wrist ratio. Patients were subjectively surveyed using visual analogus scales for wrist pain. The results were evaluated according to the Krimmer wrist scores.[Results]1. Wrist joints under neutral position, group A radial-scaphoid joints press-ure intensity was41.39±6.93N/cm2.radiallunate joints pressure intensity reached39.22±6.61N/cm2.Group B radial-scaphoid joints pressure intensit-y and the value of radial-lunate of radial-lunate joints are83.89±11.27N/cm and22.55±11.27N/cm2respectively,Group C radial-scaphoid joints pressure intensity arrived86.45±8.10N/cm2.radial-lunate joints pressure intensity wa-s34.11±8.10N/cm2. Under normal wrist neutral position, through the radi-al-scaphoid between joints and radial-lunate load is very even. After STT fusion, the average stress of joint surface radial-lunate is less than the normal group, and it is obvious less than the capitatenavicular fusion between joint surface radial pressure.2. preoperative side mean grip strength21.60+/-6.0kg, preoperative health side mean grip strength32.65+/-5.28kg, postoperative side mean grip strength was28.30+/-5.20kg, the health mean grip strength31.95+/-4.19kg, postoperative grip strength recovery to88.5%of the healthy side; Postoperative wrist range compared with preoperative palm bending better, back stretch improved markedly, the X-ray did not indicate bone nonunion cases, bone necrosis collapse of lunate have different degree of recovery. No wound infection was seen. VAS score wrist rest pain values shape:4.57+/1.16. preoperatively and postoperatively was1.23+/-0.85; Load conditions: 7.12+/-1.39preoperatively and postoperatively was2.53+/-1.11, the difference was statistically significant (p<0.05.) the Mayo wrist score was79. postoperative the excellent and good rate was84.6%.[Conclusion]1. In the treatment of Ⅲb phase of Kienbock’s disease, compared with the two operations above, STT fusion is an appropriate option for the patients from biomechanics.2. STT arthrodesis using NT-STTAC can save most of the wrist joint function and it is a realiable and effective way to treat aseptic lunatenecrosis.