• Archives of Reconstructive Microsurgery
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• 제21권1호
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• pp.68-75
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• 2012

Purpose: The purpose of this study was to evaluate the clinical results of the 4+5th extensor compartmental artery pedicled vascularized bone graft in advanced Lichtman stage III Kienbock's disease. Materials and Methods: Eight patients with advanced Lichtman stage III Kienbock's disease who underwent the 4+5th extensor compartmental artery pedicled vascularized bone graft and followed up more than 1 year were analyzed retrospectively. There were 3 men and 5 women. The mean age was 43.6 years old. Two patients were Lichtman stage IIIA and six patients were IIIB. The clinical outcomes were evaluated with radiocarpal joint pain, range of motion, grip strength, carpal-height ratio, radioscaphoid angle, return to daily living activity and/or work. The mean follow up period was 38.5 months (range from 12 to 86 months). Results: On last follow up, the pain was disappeared in 6 patients, and mild occasional pain was remained in 2 patients. Mean radiocarpal joint flexion and extension were 55 degrees and 60 degrees, 87% and 88% of the normal side, respectively. The carpal-height ratio was maintained or improved in 6 patients and slightly decreased in 2 patients. Radioscaphoid angle were improved or maintained in 7 patients. Mean grip strength was 67 lb, 93% of the normal side. All 8 patients returned to daily living activities and/or their previous works. Conclusion: The 4+5th extensor compartmental artery pedicled vascularized bone graft prevented the progression of disease and provided clinical improvement even in advanced Lichtman stage III Kienbock's disease.

• 대한정형외과학회지
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• 제56권6호
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• pp.461-471
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• 2021

Kienböck 질환을 완관절의 월상골에 발생한 무혈성 괴사로 정의하고 있지만 원인과 자연경과, 적정한 치료 방법에 대해서는 정확하게 밝혀져 있지 않다. 교과서적으로는 병의 진행 단계를 나누고 단계에 따라 치료 방법을 제시하고 있지만 과연 원칙에 맞는 올바른 치료 방법인지에 대한 충분한 검증 없이 따르고 있는 것은 아닌가 하는 의문이 드는 것도 사실이다. 저자는 그동안 많은 Kienböck 질환을 진단하고 치료를 하면서 교과서에 기술된 내용 중에서 의문이 드는 부분이 많았으며, 자료 분석과 경험을 토대로 나름대로의 적정한 치료 접근을 정립하고자 하였다. 본 종설에서는 기존의 지식이 과연 정확한 근거를 바탕으로 한 것인지 검토해 보면서 합리적인 치료 방법에 대한 저자의 의견을 제시해 보고자 한다.