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DOI: 10.1055/s-0030-1254122
© Georg Thieme Verlag KG Stuttgart · New York
Lunatumnekrose: eine aktuelle Zusammenfassung mit Langzeitergebnissen der therapeutischen Verfahren
Kienböck's Disease: An Actual Summary with Long-Term Results of the Therapeutic OptionsPublication History
eingereicht: 9.12.2009
akzeptiert: 29.4.2010
Publication Date:
09 June 2010 (online)
![](https://www.thieme-connect.de/media/hamipla/201003/lookinside/thumbnails/10.1055-s-0030-1254122-1.jpg)
Zusammenfassung
Nur wenige Erkrankungen des Karpus weisen ein so breites operativ-therapeutisches Spektrum auf wie die Lunatumnekrose. Ziel der biomechanisch sehr unterschiedlichen Konzepte ist den schicksalhaften Karpuskollaps und die Entstehung der Handgelenkarthrose zu vermeiden. Um die Leistungsfähigkeit der einzelnen Operationsmethoden einschätzen zu können, sollte eine kritische Auswertung der publizierten Langzeitergebnisse erfolgen. 20 Langzeitstudien (Nachuntersuchung durchschnittlich >10 Jahre) wurden ausgewertet, die Ergebnisse der einzelnen Studien dargestellt. Die Dekompressionsosteotomien führen zu einer Schmerzfreiheit in 20–67%, einer Beweglichkeit von 80–87%, einem Krankheitsfortschreiten in 20–50% und einer Arthroseentstehung in 25–73%. Demgegenüber erzielen Revaskularisierungsoperationen Schmerzfreiheit in 35–72%, eine Beweglichkeit von 68–81%, einen Krankheitsprogress von 11–100% und eine Arthroseentwicklung von 32–100%. Die im fortgeschrittenen Stadium angewandten Rettungseingriffe führen zu einer Schmerzfreiheit in 38–50%, einem Bewegungsumfang von 61–78% und einer Arthroseentwicklung von 24–48%. Anhand der aufgelisteten Langzeitstudien konnte gezeigt werden, dass die differenzialtherapeutischen Überlegungen in erster Linie die anatomischen Bedingungen und das Erkrankungsstadium berücksichtigen sollten. Aufgrund der eingeschränkten Vergleichbarkeit der Studien war die Erstellung eines allgemeingültigen Therapiealgorithmus anhand der dargestellten Langzeitergebnisse nicht möglich.
Abstract
Only a few diseases are treated by such a wide spectrum of therapeutic options as avascular necrosis of the lunate bone. The ultimate aim of all these very different biomechanical concepts is to avoid carpal collapse and wrist osteoarthritis. To be able to assess the efficiency of the separate operative methods, a crucial analysis of the present long-term publications is needed. We have reviewed 20 long-term studies (mean follow-up interval >10 years) to evaluate the different therapeutic options. The main results of these publications have been collected here. Decompression osteotomies can provide in the long term a ROM of 80–87%, a pain-free state in 20–67%, a progression in 20–50% and osteoarthritis in 25–73% of the cases. In contrast, revascularisation procedures can provide in the long term a ROM of 68–81%, pain-free state in 35–72%, progression in 11–100% and osteoarthritis in 32–100%. Salvage procedures can be applied at a later stage of the disease; they can provide in the long term a ROM of 61–78%, pain-free state in 38–50%, and osteoarthritis in 24–48% of the cases. Based on the listed long-term studies, it was demonstrated that a differentiated therapy should be based on the anatomic conditions and stage of the disease. Due to the restricted comparability of the studies, the formulation of a common therapy algorithm was not possible.
Schlüsselwörter
Lunatumnekrose - Revaskularisation - aseptische Nekrose - Arthrose
Key words
Kienböck's disease - revascularisation - aseptic necrosis - osteoarthritis
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Korrespondenzadresse
Dr. med. Semmelweis Univ. Balázs Kaszap
Klinikum der Johann Wolfgang
Goethe-Universität Frankfurt am Main
Orthopädische Universitätsklinik Friedrichsheim
Marienburgstraße 2
60528 Frankfurt am Main
Email: kaszapb@gmail.com