| Popis: |
It has been over 100 years since the initial description of avascular necrosis of the lunate, but it is still called mysterious disease. With time, many new information about the etiology, natural history, classification and treatment options for lunate osteonecrosis appeared. There have been new classifications developed based on advanced imaging, perfusion studies of lunate viability and arthroscopic assessment of the articular cartilage. According to that, algotithm for treatment Kienbock disease, depending on the stage of disease developed. For patients in earliest stages, if nonoperative measures fail, then vascularised bone graft with appripriate lunate unloading procedures( radial or capitate shortening) should be considered. If the lunate is "compromised" it can also be reconstructed with the spongioplasty and VBG, or treated with proximal row carpectomy if it is completely destroyed. With the furder collapse of the lunate the wirst is also compromised, with the development of secondary degenerative changes leading to condition when only a salvage procedure can be preformed. The final decision on type of treatment must be based not only on these objective pathoanatomical factors but also various patient factors (age, general health, lifestyle and future demands on the wirst). In this study we present diferent available operative procedures for treatment of Kienbock disease, their benefits and drawbacks. |
