腕关节镜下移植髂骨治疗缺血性月骨坏死Ⅱ期的临床疗效观察OA

Objective To investigate the clinical efficacy of iliac bone grafting under wrist arthroscopy and its effect on wrist function in the treatment of stage Ⅱ avascular necrosis of the lunate.Methods Between January 2020 and January 2023,80 patients with stage Ⅱ avascular necrosis of the lunate were enrolled.Forty patients were treated with wrist neutral posi-tion brace fixation(brace group),including 17 males and 23 females,aged from 31 to 55 years with a mean of(41.38±5.52)years.The remaining 40 patients were treated with iliac bone grafting under wrist arthroscopy(bone graft group),including 15 males and 25 females,aged from 29 to 52 years with a mean of(42.00±5.13)years.All patients in both groups underwent pre-operative CT and other imaging examinations to confirm the status of lunate necrosis.The wrist function was evaluated using the Mayo wrist score,and pain severity was assessed using the visual analog scale(VAS)preoperatively and at 1,3,6,and 12 months postoperatively.Grip strength,wrist height ratio,radioscaphoid angle,and wrist range of motion were measured and compared preoperatively and at 12 months postoperatively.At 12 months postoperatively,clinical efficacy was evaluated using the Cooney scoring system,and complications in both groups were recorded.Results All patients were followed up for 1 year.Compared with preoperative values,the total Mayo scores in both groups increased gradually at 1,3,6,and 12 months postop-eratively,with statistically significant differences(all P＜0.001).There were no significant differences in Mayo wrist scores be-tween the brace group and the bone graft group preoperatively and at 1 month postoperatively(P＞0.05).At 3,6,and 12 months postoperatively,the total Mayo scores in the bone graft group(66.93±1.87),(79.00±2.47),(90.00±2.60)were higher than those in the brace group(63.98±2.25),(71.98±2.17),(80.53±1.72),there were statistically significant differences(all P＜0.001).Compared with preoperative and 1 month postoperative values,the VAS scores decreased gradually at 3,6,and 12 months postoperatively,with statistically significant differences(all P＜0.001).There was no significant difference in preopera-tive VAS scores between the brace group and the bone graft group(P＞0.05).At 1,3,6,and 12 months postoperatively,the VAS in the bone graft group(4.59±0.82),(2.80±0.64),(1.66±0.69),(0.98±0.57)were lower than those in the brace group(5.23±0.97),(4.05±0.90),(2.05±0.75),(1.58±0.59),with statistically significant differences(all P＜0.05).At 12 months postoperatively,the grip strength in both groups was higher than the preoperative level,while the wrist height ratio and ra-dioscaphoid angle were lower than the preoperative levels.The grip strength and wrist height ratio in the bone graft group(23.10±3.63)kg,(0.52±0.09)were better than those in the brace group(19.47±3.20)kg,(0.48±0.07),and the radioscaphoid angle(48.92±3.53)°was lower than that in the brace group(51.30±3.14)°,with statistically significant differences(all P＜0.05).At 12 months postoperatively,the ranges of motion,including dorsiflexion,palmar flexion,ulnar deviation,radial devia-tion,pronation,and supination,were all increased compared with preoperative values in both groups.All these indices were higher in the bone graft group than in the brace group,with statistically significant differences(all P＜0.05).The effective rate of treatment in the bone graft group was higher than that in the brace group,with a statistically significant difference(P＜0.05).There was no significant difference in the incidence of complications between the two groups(P＞0.05).Conclusion Iliac bone grafting under wrist arthroscopy for stage Ⅱ avascular necrosis of the lunate can improve wrist function,relieve pain relief,re-duce the limitation of wrist motion,demonstrateing reliable efficacy and favorable safety.