lunate osteochondrosis
Introduction
Introduction to lunate osteochondrosis Lunar osteochondrosis, also known as aseptic necrosis of the moon. Occurs between the ages of 20 and 30, there are very few people under the age of 15 years, more men than women, the right wrist is more common than the left wrist. Due to the late onset of the disease, the development of the carpal bone is complete, which is different from the general osteochondrosis. However, from the pathological point of view, it is indeed a sterile necrosis, but the cause is not certain. The disease occurs in manual labor, especially in the use of vibrating tools such as wind, etc., some patients have a history of wrist or hand injury, so acute and chronic injury factors are often considered as the main cause of the disease. basic knowledge The proportion of illness: 0.001% Susceptible people: Occurs between 20 and 30 years old, more men than women. Mode of infection: non-infectious Complications: Arthritis
Cause
Causes of lunate osteochondrosis
Aseptic necrosis (20%):
Due to the late onset of the disease, the development of the carpal bone is complete, many scholars believe that it is different from the general osteochondrosis, but from the pathological performance, it is indeed a sterile necrosis, but the cause is still not certain, the disease Occasionally for manual workers, especially in the use of vibrating tools such as wind, etc., some patients have a history of wrist or hand injury, so anxious.
Chronic injury (20%):
Often considered as the main cause of the disease, but many patients have no history of injury, Gelberman found that there are 7% of the lunate bone, only 1 to 2 thin blood vessels on the volar side to supply nutrients, he thinks this moon bone is easy Sterile necrosis occurs. Some people notice that people with short ulna are prone to this disease. It may be because the lunate bone can only come into contact with the tibia, the area is relatively reduced, and the stress is relatively large and vulnerable to damage.
Prevention
Lunar osteochondrosis prevention
Because the cause of this disease is not clear, and there may be more pathogenic factors, the prevention of this disease should start from various possible causes, take preventive measures to prevent hand trauma, try to avoid excessive fatigue of the wrist, for some need to use Vibrating tools such as windswept occupations should take certain work protection or pay attention to rest.
Complication
Complications of lunate osteochondrosis Complications
The disease begins with ischemic necrosis of the lunate bone, which can be followed by synovial inflammation of the wrist joint. The density and shape of the lunate bone change, resulting in paralysis, lumbar articular surface wear, arthritis, dislocation of the wrist bone, and instability of the wrist joint. In the late stage, the patient's hand grip strength is low, the wrist joint pain and function are completely lost, and the disability rate is high.
Symptom
Symptoms of lunate osteochondrosis Common symptoms Joint pain Pain in the wrist of the wrist and joints in the wrist and joints... Aseptic necrosis of the carpal tunnel syndrome
Early characteristic signs of aseptic necrosis of the lunate bone: wrist and joint pain, tenderness of the lumbar region of the wrist and back with axial axillary pain of the third metacarpal and dysfunction of the wrist joint, the average palmar dorsiflexion is about 80°; The grip strength of the hand is reduced, averaging 60% of the healthy side.
Clinically, the disease is divided into four phases:
(1) Stage I only shows wrist pain, especially when the wrist is stretched back, and there is no change in the X-ray film;
(2) The wrist pain in stage II is further aggravated. The grip strength of the hand is lower than that of the healthy side. The X-ray shows an increase in the monthly bone density, and the trabecular bone has irregular changes, but the shape of the lunate bone is normal;
(3) Stage III manifested as wrist swelling and pain, pain can be radiated to the forearm, and the wrist extension is obviously limited. The X-ray film shows that the lunate bone is compressed and flattened, and the bone density is obviously uneven, but no bone fragments;
(4) Stage IV combined with lumbar bone fragments on the basis of stage II and III lesions, occasionally with carpal tunnel syndrome.
Examine
Examination of lunate osteochondrosis
The auxiliary examination methods for this disease are mainly X-ray examination, isotope 99mTc examination and MRI examination:
(1) X-ray performance: no positive findings at the beginning, after several weeks to several months, the monthly bone density increased, and a circular or oval light-transmissive area gradually appeared in the center, followed by irregular fragmentation, lunate bone The longitudinal diameter is shortened, and the anteroposterior diameter is increased. In the later stage, the proximal edge of the lunate bone is irregular, the fracture or even disappears, the joint space is enlarged, the adjacent bones are sparse, and the changes of osteoarthritis can be seen in the late stage.
(2) Isotope 99mTc bone scan is an effective diagnostic method for each stage of aseptic necrosis of the lunate bone. Especially in the É phase, when the diagnosis of X-ray film is not clear, it appears as a phenomenon of nuclear concentration in the lumbar region. This high-sensitivity feature is important for the diagnosis of early aseptic necrosis of the lunate bone, but this feature is not specific, in the case of carpal fracture, ulnar carpal impact syndrome, triangular fibrocartilage injury and synovitis Nuclear concentration can occur, so other tests should be combined to make a definitive diagnosis.
(3) Magnetic resonance imaging (MR I) is most sensitive to ischemic changes in the carpal bone, and shows a low signal on the T 1 and T 2 enhanced images. It is characterized by MR I can be judged when the É X-ray film cannot be judged. Clearly showing ischemic changes, therefore, it is of great significance for the early diagnosis of aseptic necrosis of the lunate bone. At the same time, MR I can be used to judge the therapeutic effect and the course of the disease, such as the T 2 enhanced image on the low signal area. A point-like high-signal zone or an equal-signal zone indicates a tendency for the monthly bone blood to recover.
Diagnosis
Diagnosis and differentiation of lunate osteochondrosis
diagnosis
Early symptoms of aseptic necrosis of the lunate bone are not typical, only wrist pain, lumbar pain in the lumbar region and mild dysfunction of the wrist, easy and soft tissue contusion of the wrist, chronic strain, wrist rheumatoiditis, tenosynovitis, cyst and ulna carpal The impact syndrome is confused, X-ray film is not accurate for early diagnosis, so it is easy to neglect and miss the diagnosis, and the lesions develop to the advanced stage, leading to collapse of the bone, fragmentation and traumatic arthritis. Therefore, improve the early clinical diagnosis rate. It is the key to ensuring the treatment effect and reducing the disability rate.
Differential diagnosis
There is no need to distinguish it from the disease.
