{"id":1423952,"date":"2025-01-13T00:00:00","date_gmt":"2025-01-12T21:00:00","guid":{"rendered":"https:\/\/analyse.optim.biz\/?p=1423952"},"modified":"2025-01-13T00:00:00","modified_gmt":"2025-01-12T21:00:00","slug":"boala-kienbock","status":"publish","type":"post","link":"https:\/\/analyse.optim.biz\/?p=1423952","title":{"rendered":"Boala Kienbock"},"content":{"rendered":"<div class=\"entry-content\">\n<div id=\"attachment_316741\" class=\"wp-caption alignright\"><img decoding=\"async\" aria-describedby=\"caption-attachment-316741\" loading=\"lazy\" class=\"size-medium wp-image-316741\" src=\"https:\/\/analyse.optim.biz\/wp-content\/uploads\/2026\/01\/taranu-razvan-300x197-1.png\" alt=\"Dr. R\u0103zvan \u021a\u0103ranu, medic specialist Ortopedie-Traumatologie, Arcadia\" width=\"300\" height=\"197\" title=\"taranu-razvan-300x197-1\"><\/p>\n<p id=\"caption-attachment-316741\" class=\"wp-caption-text\"><a href=\"https:\/\/www.arcadiamedical.ro\/echipa-medicala\/taranu-razvan\">Dr. R\u0103zvan \u021a\u0103ranu<\/a>, medic specialist Ortopedie-Traumatologie, <a href=\"http:\/\/www.arcadiamedical.ro\">Arcadia<\/a><\/p>\n<\/div>\n<p>Boala Kienbock (necroza avascular\u0103 a osului semilunar) este o <strong>afec\u021biune rar\u0103, prezent\u0103 la nivelul pumnului prin afectarea vasculariza\u021biei unuia dintre oasele carpiene, mai precis a osului semilunar<\/strong>. Afecteaz\u0103 cu predilec\u021bie pacien\u021bii de sex masculin \u00eentre 20-40 de ani. Boala Kienbock se manifest\u0103 prin <strong>durere la anumite mi\u0219c\u0103ri \u0219i sc\u0103derea for\u021bei de prehensiune<\/strong> (prinderea obiectelor). Etiologia este considerat\u0103 a fi multifactorial\u0103, incluz\u00e2nd <strong>factori biomecanici<\/strong> (varianta negativ\u0103 a cubitusului \u00een rela\u021bie cu radiusul \u2013 cubitus mai scurt, \u00eenclinarea radial\u0103 redus\u0103, traumatisme repetate) sau <strong>factori anatomici<\/strong> (geometria semilunarului, conforma\u021bia vasculariza\u021biei arteriale).<\/p>\n<p>\u00a0<\/p>\n<p><strong>Clasificarea Bolii Kienbock<\/strong><\/p>\n<p>Diagnosticul se stabile\u0219te \u00een principal pe evaluarea radiologic\u0103 (radiografie, CT, RMN), care utilizeaz\u0103 clasificarea Lichtman:<\/p>\n<p><strong>Stadiul I:<\/strong> modific\u0103ri doar pe examenul RMN;<\/p>\n<p><strong>Stadiul II:<\/strong> scleroza semilunarului;<\/p>\n<p><strong>Stadiul III:<\/strong><\/p>\n<ol>\n<li>colapsul semilunarului f\u0103r\u0103 rota\u021bia scafoidului;<\/li>\n<li>colapsul semilunarului cu rota\u021bia fix\u0103 a scafoidului;<\/li>\n<\/ol>\n<p><strong>Stadiul IV:<\/strong> artroza articula\u021biilor intercarpiene.<\/p>\n<p>\u00a0<\/p>\n<p><strong>Tratamentul Bolii Kienbock<\/strong><\/p>\n<p>Tratamentul <strong>se stabile\u0219te \u00een func\u021bie de severitatea simptomelor, stadiul radiologic \u0219i expertiza chirurgical\u0103<\/strong> \u0219i este <strong>foarte variabil:<\/strong> imobilizare, osteotomie par\u021bial\u0103 de os capitat, osteotomie\/decompresie a radiusului distal, carpectomie proximal\u0103, revascularizare cu grefon osos, artrodez\u0103 par\u021bial\u0103\/total\u0103 a pumnului, artroplastie a pumnului.<\/p>\n<p>\u00a0<\/p>\n<p><strong>Pacient de 35 de ani cu Boala Kienbock, tratat cu succes la Arcadia<\/strong><\/p>\n<p>Prezent\u0103m cazul unui pacient \u00een v\u00e2rst\u0103 de 35 de ani, care acuza <strong>durere \u00een pumnul st\u00e2ng de aproximativ 2 ani<\/strong> (9\/10 pe Scala Analog Vizual\u0103 \u2013 VAS). Simptomele ap\u0103reau at\u00e2t la mi\u0219c\u0103rile de flexie\/extensie, c\u00e2t \u0219i \u00een repaus \u0219i \u00eei afectau capacitatea de a efectua activit\u0103\u021bile zilnice. Pacientul nu suferise niciun traumatism \u00een antecedente. Efectuase diverse tratamente (fizioterapie, infiltra\u021bii cu PRP \u0219i acid hialuronic, ortez\u0103), f\u0103r\u0103 ca acestea s\u0103 \u00eei ofere vreun beneficiu.<\/p>\n<p><strong>Examenul clinic al pumnului st\u00e2ng<\/strong><strong>a demonstrat durere la palparea semilunarului,<\/strong> flexie \u2013 60 grade, extensie \u2013 30 grade, prona\u021bie \u0219i supina\u021bie \u2013 80 grade. <strong>Examenul radiologic (radiografie \u0219i CT) al pumnului st\u00e2ng a confirmat diagnosticul de Boal\u0103 Kienbock \u00een stadiul III A<\/strong> (osteonecroza semilunarului cu u\u0219or colaps). Nu s-a observat diferen\u021b\u0103 de lungime \u00eentre radius \u0219i uln\u0103 (varianta neutr\u0103) \u0219i nici rota\u021bia scafoidului.<\/p>\n<p>Av\u00e2nd \u00een vedere c\u0103 tratamentul conservator nu a ameliorat simptomele, <strong>s-a propus interven\u021bia chirurgical\u0103 care a constat \u00een osteotomia par\u021bial\u0103 a osului capitat<\/strong> pentru reducerea presiunii asupra osului semilunar \u0219i denervarea par\u021bial\u0103 a pumnului prin abla\u021bia ramurilor terminale articulare ale nervilor interosos posterior \u0219i interosos anterior.<\/p>\n<p>La interval de 4 luni postoperator, pacientul a afirmat c\u0103 <strong>durerea a sc\u0103zut<\/strong> de la 9\/10 la 4\/10 pe Scala Analog Vizual\u0103 (VAS), aceasta fiind resim\u021bit\u0103 doar ocazional \u00een timpul unor activit\u0103\u021bi fizice intense. De asemenea, s-a observat o \u00eembun\u0103t\u0103\u021bire a scorului QuickDASH de la 68.2 la 15.9.<\/p>\n<p>\u00a0<\/p>\n<p><strong>Concluzii<\/strong><\/p>\n<ol>\n<li>Boala Kienbock necesit\u0103 diagnostic precoce \u00eentruc\u00e2t complexitatea tratamentului cre\u0219te pe m\u0103sur\u0103 ce stadiul radiologic avanseaz\u0103.<\/li>\n<li>Conduita terapeutic\u0103 depinde at\u00e2t de stadiul radiologic, c\u00e2t \u0219i de experien\u021ba medicului curant.<\/li>\n<\/ol>\n<p>\u00a0<\/p>\n<p>Pentru programarea unei consulta\u021bii, pacien\u021bii au la dispozi\u021bie num\u0103rul de telefon <strong>0232 920, Call Center Arcadia.<\/strong><\/p>\n<p><a href=\"http:\/\/www.arcadiamedical.ro\">www.arcadiamedical.ro<\/a><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Dr. R\u0103zvan \u021a\u0103ranu, medic specialist Ortopedie-Traumatologie, Arcadia Boala Kienbock (necroza avascular\u0103 a osului semilunar) este o afec\u021biune rar\u0103, prezent\u0103 la nivelul pumnului prin afectarea vasculariza\u021biei unuia dintre oasele carpiene, mai precis a osului semilunar. Afecteaz\u0103 cu predilec\u021bie pacien\u021bii de sex masculin \u00eentre 20-40 de ani. Boala Kienbock se manifest\u0103 prin durere la anumite mi\u0219c\u0103ri \u0219i [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[89],"tags":[174],"class_list":["post-1423952","post","type-post","status-publish","format-standard","hentry","category-romania","tag-suceavanews-ro"],"_links":{"self":[{"href":"https:\/\/analyse.optim.biz\/index.php?rest_route=\/wp\/v2\/posts\/1423952","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/analyse.optim.biz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/analyse.optim.biz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/analyse.optim.biz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/analyse.optim.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1423952"}],"version-history":[{"count":0,"href":"https:\/\/analyse.optim.biz\/index.php?rest_route=\/wp\/v2\/posts\/1423952\/revisions"}],"wp:attachment":[{"href":"https:\/\/analyse.optim.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1423952"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/analyse.optim.biz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1423952"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/analyse.optim.biz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1423952"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}