摘要
目的探讨月骨无菌性坏死诱因、临床分期及治疗的研究进展。方法以"月骨""缺血坏死""临床分期""治疗"以及"lunate bone""avascular necrosis""clinical stages""treatment"为关键词,在中国知网、万方数据库,以及PubMed、SinoMed等中英文数据库中检索2023年1月之前发表的有关月骨无菌性坏死研究的文献共1004篇,剔除重复检索、内容相关性低、无法获得全文、质量较低及创新性差的文献,最终纳入了61篇文献,总结分析月骨无菌性坏死诱因、临床分期及治疗方法。结果月骨无菌性坏死是较常见的骨坏死性疾病,诱发因素有解剖因素和非解剖因素两大类。解剖因素包括月骨血供、月骨形态、月骨生物力学、桡骨解剖学参数、尺骨变异,非解剖因素包括骨折、遗传因素等。对于月骨无菌性坏死的分期,使用最广泛的是Lichtman X线分期,Schmitt MRI分期和Bain关节镜分级目前也用于该疾病的分类;而Lichtman新分类可以更好地指导骨科医师对月骨无菌性坏死患者的治疗。儿童与老年人月骨无菌性坏死以保守治疗为主;成年患者在行手术治疗前应予以3~6个月的制动保守治疗。手术方式的选择:对于关节面完好并且血运预后良好的月骨应行月骨减压术;若月骨出现部分关节面损伤应予以月骨重建术;若月骨已经塌陷,并且没有血运重建的潜力,应予以切除月骨;若桡月关节面或腕中关节面损伤,应予以局限性腕关节融合术;若桡舟关节也损伤,应予以全腕关节融合术。结论月骨无菌性坏死的发生是多种危险因素互相作用的结果,其治疗的关键在于准确判断该疾病的分期,而Lichtman新分类遵循个体化治疗原则,可以精确对该疾病分期。月骨无菌性坏死治疗可分为保守治疗、手术治疗,其中手术治疗应根据患者分期及疾病进展程度来决定。
Objective This study aimed to summarize the causes,staging,and treatment of aseptic necrosis of the lunate bone.MethodsThekeywords"月骨""缺血坏死""临床分期""治疗""lunate bone""avascular necrosis""clinical stages"and"treatment"were searched in Chinese and English databases such as CNKI,Wanfang,PubMed,and SinoMed.A total of 1004 articles on aseptic necrosis of the lunate bone published before January 2023 were retrieved.After excluding articles with repeated retrieval,low content correlation,an inability to obtain full text,low quality,and poor innovation,61 articles were finally included to summarize and analyze the causes,clinical stages,and treatment methods of aseptic necrosis of the lunate bone.Results Aseptic necrosis of the lunate bone is a common osteonecrosis,which can be induced by anatomical and non-anatomical factors.The anatomical factors include lunate blood supply,lunate bone morphology,lunate bone biomechanics,radial anatomical parameters,and ulna variation.The non-anatomical factors include fracture and genetic factors.The Lichtman staging system is the widely used staging system for aseptic necrosis of the lunate bone.The Schmitt MRI staging system and Bain arthroscopic staging system are also used for the classification of the disease.The new Lichtman classification can guide orthopedic surgeons to treat patients with aseptic necrosis of the lunate bone.Conservative treatment is the main treatment for children and elderly patients with aseptic necrosis of the lunate bone.Adult patients should be treated conservatively for 3 to 6 months before surgery.In the selection of surgical methods,lunate decompression should be considered for the lunate with an intact articular surface and good blood supply prognosis.If there is a partial articular surface injury of the lunate bone,then lunate bone reconstruction should be performed.If the lunate has collapsed and shown no potential for revascularization,then the lunate should be resected.In addition,limited wrist arthrodesis should be performed
作者
赵潇雄
王鹏飞
王玮
崔展华
常文凯
Zhao Xiaoxiong;Wang Pengfei;Wang Wei;Cui Zhanhua;Chang Wenkai(Department of Orthopedics,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)
出处
《中华解剖与临床杂志》
2023年第7期486-492,共7页
Chinese Journal of Anatomy and Clinics
关键词
月骨
月骨无菌性坏死
临床分期
治疗
Lunate bone
Aseptic necrosis of the lunate bone
Clinical stages
Treatment
