Zusammenfassung
Die Operation nach Saffar wird heute nur noch selten angewendet. Um den Stellenwert dieses Verfahrens bei der Behandlung der Mondbeinnekrose zu bewerten, konnten wir 7 von 12 Patienten untersuchen, die im Mittel vor 19 Jahren durch Exstirpation des Os lunatum und Transposition des gestielten Os pisiforme behandelt worden waren. Alle nachuntersuchten Patienten waren ohne Einschränkungen voll erwerbstätig, es gab keinen erkrankungsbedingten Berufswechsel. Der DASH-Wert betrug im Mittelwert 5,9. Der Mittelwert der mit der VAS (visuelle Analogskala) ermittelten Schmerzen betrug 0,9, wobei 4 Patienten vollständige Schmerzfreiheit angaben. Die Kraft betrug im Mittel 77 % der nicht operierten Seite, das Bewegungsausmaß war bei einem aktiven ROM von 97° (Extension/Flexion) im Vergleich zur gesunden Seite auf 72 % reduziert. Alle Patienten gaben eine hohe Zufriedenheit an und würden sich erneut auf diese Art und Weise operieren lassen. Trotz dieser guten Ergebnisse fanden sich erhebliche radiologische Veränderungen: In 5 Fällen fand sich eine fortgeschrittene interkarpale Arthrose. Bei vier Patienten entwickelte sich eine spontane Synostose zwischen dem Os pisiforme und dem Os triquetrum. Der CHR-Mittelwert (Carpal Height Ratio) als Ausdruck des karpalen Kollaps betrug 0,43. Nach unseren Langzeitergebnissen zeigen sich nach der Transposition des gestielten Os pisiforme eine hohe Patientenzufriedenheit und gute funktionelle Ergebnisse trotz erheblicher radiologischer Veränderungen.
Abstract
Saffar's procedure is used only rarely today. In order to assess the value of this operation in the treatment of advanced Kienböck's disease, after a mean follow-up period of 19 years we could review 7 of 12 patients who had had their lunate replaced by the vascularised pisiform. At the time of follow-up all patients were fully employed without restrictions, and no patient had had to change his job. The mean DASH score was 5.9. The average pain level by VAS was 0.9 and four patients were totally free of pain. Grip strength of the affected arm was reduced to 77 % of the opposite side, the active range of motion (extension/flection) was 97°, which was 72 % of that of the not affected side. All patients reported high satisfaction with the results of the operation. Although the clinical results were very good, we found substantial radiographical alterations: In 5 patients we found an advanced intercarpal osteoarthritis. Four patients presented a spontaneous synostosis between the pisiform and the triquetrum. The average CHR (carpal height ratio) was 0.43. The presented long-term results after lunate replacement by the vascularised pisiform indicate a high patient satisfaction and very good functional results in spite of significant radiological changes.
Schlüsselwörter
Handwurzelknochen - Mondbeinnekrose - Transposition des vaskularisierten Os pisiforme - Langzeitergebnisse
Key words
carpal bones - Kienböck's disease - lunate replacement by vascularised pisiform - long‐term results
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Dr. med. Bernd von Maydell
Hand- und Plastische Chirurgie
Malteser-Krankenhaus Bonn/Rhein-Sieg
Von-Hompesch-Straße 1
53123 Bonn
eMail: dr@maydell.info
