期刊
JOURNAL OF HAND SURGERY-AMERICAN VOLUME
卷 28A, 期 5, 页码 767-778出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/S0363-5023(03)00260-0
关键词
aseptic necrosis scaphoid; avascular necrosis scaphoid; ischemic necrosis scaphoid; osteochondritis dissecans scaphoid; Preiser's disease
Purpose: A large series of patients with Preiser's disease, was reviewed to compare 2 potentially different categories of this disorder: complete versus partial vascular impairment of the scaphoid bone as determined by magnetic resonance, imaging (MRI). Methods: Nineteen patients with Preiser's disease were, identified retrospectively from 2 institutions. Using MRI criteria, 2 disease patterns were identified: diffuse necrosis and/or ischemia of the scaphoid (type 1 disease, 11 cases) and segmental vascular impairment of the scaphoid (type 2 disease, 8 cases). Risk factors for osteonecrosis, treatment methods, and serial radiographs were reviewed in all cases. Sixteen patients were examined for the purpose of this study at an average follow-up of 25 months. Results: MRI signal changes of necrosis and/or ischemia involved 100% of the scaphoid in type 1 cases and on average approximately 42% in type 2 cases (range, 33% to 66%). In type 1 cases, regardless of the treatment used, the scaphoid typically fragmented and collapsed. In type 2 cases, scaphoid architecture was altered minimally after similar treatment methods. A history of wrist trauma was significantly more common in type 2 cases, and the results of treatment were generally better in this group of patients (mean Mayo modified wrist scores, 86 vs 58 points). Conclusions: This study supports the concept of 2 patterns of scaphoid involvement in Preiser's disease. Type I cases are characterized by MRI signal changes of necrosis and/or ischemia involving the-entire scaphoid bone. Patients in this group have a-propensity for scaphoid deterioration. Type 2 cases have MRI signal changes involving only part of the scaphoid. These patients commonly report a history of wrist trauma, show fewer tendencies toward scaphoid fragmentation, and may have a more favorable clinical outcome. Copyright (C) 2003 by the American Society for Surgery of the Hand.
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