Objective: Metaphyseal core decompression (MCD) of the radius is known as minimally invasive treatment option for lunate avascular necrosis. As treatment of early stages, whether conservatively or surgically, still remains in discussion, we analyzed a consecutive magnetic resonance imaging (MRI) controlled series of MCD to evaluate effectiveness on short-term and mid-term follow-up. Materials and Methods: Between 2008 and 2015, 14 consecutive patients with lunate avascular necrosis (Lichtman stages I n = 5/II n = 6/IIIA n = 3) were included. Diagnosis and determination of ulna variance were based on native MRI and x-ray images. MCD’s were performed in ambulatory setting by 1 surgeon. Postoperative regime consisted in 4 weeks of cast immobilization and a splint during daytime for another 12 weeks without heavy loading. Early postoperative MRI controls (range, 3 to 8 months postoperatively) evaluated bone edema and signs of progression: normal bone signal (1); reduction of edema, but not normal (2); and unchanged edema or signs of progression (3). As several asymptomatic patients refused a final follow-up visit, we framed questions for self-evaluation by telephone interview. Accordingly, pain was recorded as painless (1), pain only after heavy loading but no splint or medication needed (2), or any worse (3). Return to work and sports was recorded both positive (1), only work positive (2), and work negative (3). Mobility in wrist flexion-extension was compared with the opposite, normal side, and described by the patient as normal (1), less without functional impairment (2), or worse: less with functional impairment (3). Grip strength was described by the patient discriminating between normal (1), less without functional impairment (2), or worse: less with functional impairment (3). Results: Ulna variance was negative (n = 5), neutral (n = 6), or positive (n = 3). Within 10 weeks after surgery (mean, 5.7 weeks), all patients had returned to their previous occupation (1), no complications were observed. Postoperative MRI controls were obtained in 13 patients confirming reduction of lunate bone marrow edema (2) in all cases except one (3), being normal in 5 (1). One patient with an electronic implant could not have MRI control but showed normal x-ray images 14 months postoperatively. At final follow-up (mean, 35 months; range, 8-76), 11 were without pain (1) whereas 3 reported pain only after heavy loading in hyperextension of the wrist (2). Mobility was reported normal (1) in 13 cases and reduced without functional impairment in 1 (2). Grip strength was reported normal (1) in 11 cases and reduced without functional impairment (2) in 3. One case, even though subjectively satisfied, had progressed from stage IIIA to IIIB (neutral ulna variance). Adapted to Mayo wrist score, 13 rated excellent and 1 good. Conclusion: MCD is an extra-articular, minimally invasive, and technically easy low-cost-procedure with minor complication risk. As independently from ulna variance excellent clinical results and radiological evolution are demonstrated, similar as for established, but more complex treatment modalities, MCD is recommended as primary treatment option for low stage lunate avascular necrosis.
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机译：目的：of骨干core端减压术（MCD）被称为月经性血管坏死的微创治疗选择。由于早期治疗（无论是保守治疗还是手术治疗）仍在讨论中，因此我们分析了一系列连续的磁共振成像（MRI）控制的MCD，以评估短期和中期随访的有效性。材料和方法：在2008年至2015年期间，纳入了14例连续的月牙无血管坏死患者（Lichtman分期I n = 5 / II n = 6 / IIIA n = 3）。尺骨变异的诊断和确定是基于天然MRI和X射线图像。 MCD由一名外科医生在非卧床环境中进行。术后治疗包括4周的石膏固定和白天的夹板，另外12周没有重负荷。术后早期的MRI对照（术后3至8个月）评估了骨水肿和进展迹象：正常骨信号（1）;减轻水肿，但不正常（2）;并保持不变的水肿或进展迹象（3）。由于几名无症状患者拒绝接受最终随访，我们通过电话采访来提出自我评估的问题。因此，疼痛被记录为无痛（1），仅在重负荷后疼痛，而无需夹板或药物治疗（2），或更糟（3）。重返工作和体育运动的成绩均为正（1），仅工作为正（2）和工作为负（3）。将腕屈伸运动的相对侧与正常侧进行了比较，并被患者描述为正常（1），无功能障碍者较少（2），或更糟：功能障碍者较少（3）。通过患者区分握力（1），正常（1），功能障碍（2）或更差：功能（3）差。结果：尺骨方差为负（n = 5），中性（n = 6）或正（n = 3）。手术后10周内（平均5.7周），所有患者均恢复了以前的职业（1），未观察到并发症。在13例患者中获得了术后MRI对照，证实了除1例（3）以外其余所有病例中月球骨髓水肿的减轻（2），5例（1）正常。一名患有电子植入物的患者无法进行MRI控制，但术后14个月显示了正常的X射线图像。在最后一次随访中（平均35个月;范围8-76），有11例没有疼痛（1），而只有3例仅在手腕过度伸展时承受重负荷才报告疼痛（2）。据报告，活动性正常（1）13例，活动性降低1（2）。握力报告为正常（1）（11例），降低后无功能损害（2）（3）。有1例，尽管主观上满意，但已从IIIA阶段发展到IIIB（中性尺骨变异）。适应Mayo手腕得分，其中13分为优秀和1优秀。结论：MCD是一种关节外，微创，技术上容易的低成本手术，并发症风险较小。由于独立于尺骨变异，已证明了极好的临床结果和放射学演变，与已确立的相似，但治疗方法更为复杂，因此，MCD被推荐作为低级月经性血管坏死的主要治疗选择。
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