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Vascular bundle implantation into bone for aseptic necrosis of the lunate
1Department of Orthopedic Surgery, East-South Hospital, Fu Jian, People's Republic of China.
Insights
Vascularized bone grafts using the ramus carpeus dorsalis artery and vein successfully treated aseptic necrosis of the lunate bone. Patients experienced pain relief and returned to work, with radiographic evidence of healing.
Area of Science:
- Orthopedic Surgery
- Vascularized Bone Grafting
- Wrist Reconstruction
Background:
- Aseptic necrosis of the lunate bone (e.g., Kienböck's disease) causes significant wrist pain and dysfunction.
- Traditional treatments have limitations in restoring lunate bone viability and function.
- Surgical intervention aims to revascularize the necrotic lunate bone.
Observation:
- A surgical technique involving the implantation of a vascular bundle (ramus carpeus dorsalis artery and vein) into the lunate was performed on 11 patients.
- The average follow-up period was 36 months.
- Anatomical studies confirmed consistent and sufficient vascular supply from the ramus carpeus dorsalis for transplantation.
Findings:
- Follow-up roentgenograms demonstrated continuous repair of the necrotic lunate bone.
- Postoperative imaging showed complete disappearance of sclerosis and return to normal architecture and density.
- Radiodensity decreased by an average of 30.3 Gray scale, and cyst formations resolved.
- All patients reported pain relief and returned to their previous work, including manual labor.
Implications:
- Vascularized bone grafting of the ramus carpeus dorsalis is an effective treatment for aseptic necrosis of the lunate.
- This procedure restores lunate bone viability, function, and alleviates pain.
- The consistent anatomy of the ramus carpeus dorsalis supports its reliability as a graft source.
Abstract:
Since April 1986, implantation of a vascular bundle containing the ramus carpeus dorsalis of the interosseal anterior artery and vein into the lunate has been undertaken for aseptic necrosis of the lunate bone. A series of 11 cases were performed in East-South Hospital with satisfactory results. The average follow-up period was 36 months. A series of follow-up roentgenograms reveal that necrosis of the lunate bone is being continuously repaired. Fourteen months postoperative, the following results are obtained: (1) the sclerosis of the lunate bone has completely disappeared on the roentgenograms, (2) the architecture and density of the lunate bone have returned to normal on the roentgenograms, (3) technically colorized X-ray films show that lunate bone density decreases after the operation (the decreasing range is 20 to 44 Gray scale [mean, 30.3 +/- 2.4 Gray scale]) and that the cyst formations on the lunate bone have completely disappeared postoperatively, and (4) pain in the affected wrists disappeared and patients have returned to their former work, including manual labor. The necrotized lunate bones are healed. Anatomic study shows that the presence of the ramus carpeus dorsalis of the interosseal anterior artery and vein on the wrist is 100%, and the structure as well as location of the ramus carpeus dorsalis has little anatomic variation and is long enough to be transplanted into the lunate bone.