Abstract：Objective To observe biomechanical changes of two Ⅲb treatments lunate osteonecrosis operation period, and provide biomechanical basis for the clinical treatment of Kienbck′s disease.Methods Eighteen fresh upper limb specimens of adult patients were randomly divided into 3 groups, group A(normal wrist joint), group B(STT fusion) and group C(the capitatenavicular arthrodesis). The touch pressure sensor was put between wrist radial navicular and radial lunate clearance, specimens of proximal and distal were fixed separately with biaxial hydraulic material test system (MTS), which was connected to the computer I-scan system, dynamically specimen pressure value per unit area of radial navicular and radial lunate joint clearance in neutral position and stretch a pressure on wrist to 100 N in 20 s were recorded, two kinds of operative methods on the biomechanics effects were observed.Results Wrist joints under neutral position, group A radial-scaphoid joints pressure intensity was( 41.39±6.93 )N/cm2, radial lunate joints pressure intensity reached (39.22±6.61 )N/cm2. Group B radial-scaphoid joints pressure intensity and the value of radial-lunate joints were( 83.89±11.27)N/cm2 and(22.55±11.27) N/cm2, respectively. Group C radial-scaphoid joints pressure intensity arrived(86.45±8.10) N/cm2,radial-lunate joints pressureintensity was (34.11±8.10) N/cm2. Wrist under neutral position in group A, through radial scaphoid, radial lunate clearance joints of average load was very uniform (P>0.05). Radial lunate clearance joints of average load in group B and group C were less than those of group A (all P values<0.05), while the radial lunate joint clearance were significantly greater than the average load in group A (all P values< 0.05), and radial clearance of average load reduction in group B is more obvious.Conclusions Both STT fusion and capitatenavicular fusion can significantly reduce the radial-lunate clearance of the bearing. STT fusion can reduce more effectively on the lunate pressure load. In the treatment of Ⅲb phase of Kienbck′s disease, compared with the two operations above, STT fusion is an appropriate option for the patients from biomechanics.
李川,徐永清,徐小山,何晓清,范新宇,苏踊跃,唐辉. 两种治疗Ⅲb期月骨坏死术式的生物力学比较[J]. 中华解剖与临床杂志, 2014, 19(3): 236-240.
Li Chuan, Xu Yongqing, Xu Xiaoshan, He Xiaoqing, Fan Xinyu, Su Yongyue, Tang Hui. Biomechanical comparison between two Ⅲb period treatments forlunate osteonecrosis. Chinese Journal of Anatomy and Clinics, 2014, 19(3): 236-240.
Wagner JP, Chung KC. A historical report on Robert Kienbck (1871-1953) and Kienbck′s disease[J]. J Hand Surg, 2005, 30(6): 1117-1121.
[2]
Beredjiklian PK. Kienbck′s disease[J]. J Hand Surg, 2009, 34(1): 167-75.
[3]
Allan CH, Joshi A, Lichtman DM. Kienbck′s disease: diagnosis and treatment[J]. J Am Acad Orthop Surg, 2001, 9(2): 128-136.
[4]
Palmer AK, Werner FW, Murphy D, et al. Functional wrist motion: a biomechanical study[J]. J Hand Surg(Am), 1985, 10(1): 39-46.
[5]
Luo J, Diao E. Kienbck′s disease: an approach to treatment[J]. Hand Clin, 2006, 22(4): 465-473.
[6]
Goeminne S, Degreef I, De Smet L. Negative ulnar variance has prognostic value in progression of Kienbck′s disease[J]. Acta Orthop Belg, 2010, 76(1): 38-41.
[7]
D′Hoore K, De Smet L, Verellen K, et al. Negative ulnar variance is not a risk factor for Kienbck′s disease[J]. J Hand Surg, 1994, 19(6): 1057-1058.
[8]
Nakamura R, Nakao E, Nishizuka T, et al. Radial osteotomy for Kienbck disease[J]. Tech Hand Up Extrem Surg, 2011, 15(1): 48-54.
[9]
Mennen U, Sithebe H. The incidence of asymptomatic Kienbck′s disease[J]. J Hand Surg, 2009, 34(3): 348-350.
[10]
Han KJ, Kim JY, Chung NS, et al . Trabecular microstructure of the human lunate in Kienbck′s disease[J]. J Hand Surg, 2012, 37(4): 336-341.
[11]
Yazaki N, Burns ST, Morris RP, et al. Variations of capitate morphology in the wrist[J]. J Hand Surg, 2008, 3333(5): 660-666.
[12]
Pichler M, Putz R. The venous drainage of the lunate bone[J]. Surg Radiol Anat, 2003, 24(6): 372-6.
[13]
Innes L, Strauch RJ. Systematic review of the treatment of Kienbck′s disease in its early and late stages[J]. J Hand Surg , 2010, 35(5): 713-717, e711-e714.
[14]
Lichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienbck′s disease: the state of the art and a look at the future[J]. J Hand Surg , 2010, 35(7): 549 -554.
[15]
Van den Dungen S, Dury M, Foucher G, et al. Conservative treatment versus scaphotrapeziotrapezoid arthrodesis for Kienbck′s disease. A retrospective study[J]. Chir Main, 2006, 25(3-4): 141-145.
[16]
Tatebe M, Hirata H, Iwata Y, et al. Limited wrist arthrodesis versus radial osteotomy for advanced Kienbck′s disease for a fragmented lunate[J]. Hand Surg , 2006, 11(1-2): 9-14.
2014, Vol. 19 
