Treatment of avascular necrosis
Treatment of avascular necrosis is highlyinefficient. Conservative treatment using multiple physical therapy is essentially symptomatic and, best results in only a temporary reduction of fugitive and wrist joint pain. The most significant is the immobilization of the wrist joint, but its effectiveness even in cases where it lasts for up to 2 months is very fast invalid when the patient returns to work. Long-term treatment, long transfers to facilitate the work to which we are so happy to have recourse, are merely an attempt to delay the time of the patient's recognition of disabilities and needy in terms of disability.
There are many ways of surgical treatmentaseptic necrosis of lunate bone, but also active surgical intervention does not lead to the desired result. Removing diseased lunate bone, like a foreign body, Subhon-dralnoe excision it in suitable cases, partial resection, incision of the cortical layer of the affected bone or piercing it in many places in order to stimulate the regeneration, the formation of crescent-ray arthrodesis, excochleation lunate bone with lead seal cavity - far not a complete list of operations used in aseptic necrosis. The wide dissemination of these operations is hampered not so much by their complexity, but the fact that they are in most cases very severe ankylosing end osteoarthritis of the wrist joint, and thus, even if the patient gets rid of the pain, wrist function is lost.
Based on "negative option" of importance for theformation of avascular necrosis, Persson suggested in severe cases with a pronounced "negative option" to produce radial shortening or lengthening of the ulna in order to change the existing relations of joint sites. Persson said that of the 19 operated by this method in 14 patients obtained a good result.
Pessimistic assessment of treatment outcomes of patients withaseptic necrosis of the lunate bone is based on a sufficient number of indisputable facts. Of the 209 patients observed, only 7 (3.3%) were able, after long-term treatment to remain on their regular work. The remaining 202 have lost their skills and have been recognized as disabled, in need of constant employment for work that does not require any intense and significant in terms of movements of the hand (wrist joint, fingers).
The real disease prevention measures rather kienbockdifficult. Brush, as you know, is a "gateway vibration", but the number of working with vibrating tools has steadily increased in accordance with the needs of the national economy. Only the improvement of the vibration damping devices will reduce the effects of vibration, and many, including the incidence of necrosis of the lunate bone. In no less should include prevention and comprehensive mechanization and automation of many stressful for hand work. It is possible that an important role can play and professional selection taking into account the structural features of the articular sites radius and ulna bones, preventing a number of works, mainly related to the vibration, people with "negative option" wrist. The course of avascular necrosis of lunate bone, the tendency of the disease to the progression and irreversibility of its almost forced the doctor conducting the examination of ability to work, to take into account these circumstances and not rely on the fact that the treatment and temporary employment to facilitate the work to help the patient return to his profession. Summation of micro traumas will have its detrimental effects on the lunate bone, and a few years after the onset of the disease, and by the time the repair will come sharply altered bone is formed deforming osteoarthritis wrist with a significant limitation of hand function. Establishing the diagnosis of aseptic necrosis of lunate bone is patient acceptance disabilities. The need for such a decisive conclusion is primarily due to the disease and the characteristics of, and the fact that the vast majority of patients is appropriate representatives of heavy physical labor occupations. Employment of such patients is often not an easy task, since it is necessary to take into account that they are counter-operation that require support, shock or pressure on the wrist flexion and extensions. Many patients also have to constantly wear a splint or bandage, fixing beam-carpal joint.