Kienbock病课件.pptVIP

;女性，55岁， 主诉：右腕疼痛2年加重1年入院 现病史：2年前起无诱因右腕肿胀，疼痛，活动后明显，近一年来症状加重。 查体：右腕肿胀、腕背部压痛，腕关节活动受限，背伸45°掌屈30°尺桡偏活动正常，轴向叩击第3掌骨可诱发腕部疼痛。否认外伤史、烟酒史、药物史。;;术后2月;1843年Peste发现该病;病 因 尚不明确;病 因 1 内因学说—月骨血供特点;;月骨血供;;;病 因 2 外因学说—外伤;;病 因 3 内因学说—基因缺陷 predisposition;;病 因 4 内因学说— 尺骨负变异;;;尺骨负变异时，月骨负荷相对集中，月骨因压力增加而发生骨折、骨内微血管损伤，从而发生月骨无菌性坏死。;Hultén的研究结果（ 1928 ）;;J Hand Surg Am. 1986 Jan;11(1):95-7. Traumatic ulnar variance in Kienb?cks disease. Stahl S, Reis ND. Abstract A case of unilateral ulnar minus variant, almost certainly caused by trauma to the distal ulnar growth plate, and ipsilateral Kienb?cks disease is described. The contralateral wrist was normal in all respects. This constitutes additional evidence for the etiologic relationship between Kienb?cks disease and the presence of the ulnar minus variant. PMID: 3944454 [PubMed - indexed for MEDLINE] Stahl和Reis等观察到患者单侧腕关节创伤后尺骨负变异畸形而导致的Kienbock’s 病的典型病理过程，他们认为这为Kienbock’s 病的病因学因素增加了证据。;反对者;Negative ulnar variance is not a risk factor for Kienb?cks disease K. DHoore MD, L. De Smet MD,?K. Verellen MD The Journal of Hand Surgery Volume 19, Issue 2, March 1994, Pages 229-231? 尺、桡骨远端解剖变异与月骨缺血性坏死关系的研究?田光磊????王澍寰????韦加宁??杨克非 ?中华手外科杂志?.?1997年3期 ; Mirabello[427] and Werner and Palmer[689] both pointed out that radial slope in the anteroposterior projection can have a significant effect on both the forces transmitted to the lunate and the age at onset of Kienb?cks disease. Mirabello 、 Werner 和 Palmer均指出桡骨远端尺偏角不仅牵涉桡月关节力量传递，同时对Kienbock病初始发病年龄有明显影响。;J Hand Surg Br. 1993 Feb;18(1):70-5. Title： Anatomical risk factors for Kienb?cks disease. Author： Tsuge S, Nakamura R. Department of Orthopaedic Surgery, Branch Hospital, Nagoya University School of Medicine, Japan. Abstract Contralateral unaffected wrists from 41 males with Kienb?cks disease were compared with wrists from 66 normal males. From X-rays, various features of the lunate and radius were measured. In patients with Kienb?cks disease, the lunate tended to be smaller and inclined more