腕关节镜视下治疗三角纤维软骨复合体损伤  被引量:28

Wrist arthroscopic treatment of TFCC lesions

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作  者:徐文东[1] 沈云东[1] 蒋苏[1] 徐建光[1] 

机构地区:[1]复旦大学附属华山医院手外科,上海200040

出  处:《中华手外科杂志》2011年第5期259-262,共4页Chinese Journal of Hand Surgery

基  金:卫生部临床学科重点课题资助项目(2007-66-6).上海市周围神经显微外科重点实验室课题资助项目(08D22270600)

摘  要:目的总结应用腕关节镜技术诊断并治疗40例单纯三角纤维软骨复合体(1FCc)损伤的经验。方法40例患者中男24例,女16例;平均年龄37.3岁。应用常规腕关节镜人路和器械对桡腕关节和腕中关节进行检查,对TFCC损伤的诊断采用Palmer分型,腕关节镜视下诊断为TFCCI型损伤30例、Ⅱ型损伤10例。明确诊断后对TFCCⅠA、ⅠD型行清创术;ⅠB、ⅠC型行镜下修复术;TFCCⅡ型损伤行清创术;对有尺骨撞击的TFCCⅡC和ⅡD型损伤行关节镜下尺骨头部分磨除术(Wafer术)治疗。术前和术后随访评定采用改良Mayo腕关节功能评分。结果镜下TFCC清创及修复术均顺利;术后有1例患者出现环指主动背伸不能(后经手术探查为环指指伸肌腱断裂),余患者均无并发症;平均随访时间为11.6个月。经改良Mayo腕关节功能评分:优21例,良13例,可5例,差1例;优良率为85.0%,患者自我满意率为97.5%。结论应用腕关节镜技术诊断并治疗TFCC损伤安全有效,随访效果确切可靠,值得推广应用。Objective To summarize the experience of wrist arthroscopic diagnosis and treatment of simple TFCC lesions in 40 cases. Methods There were 24 males and 16 females in this 40 case series. The average patient age was 37.3 years. Routine wrist arthroscopy portals and instrumentation were used to exam the radiocarpal and midcarpal joints. The pathologic TFCC lesions were diagnosed according to Palmer' s Classification Scales. TFCC IA and ID lesions were treated with debridement under the arthroscopy, while IB and IC lesions were repaired. IIC and I1D lesions with ulnar head impingement underwent Wafer procedure under the arthroscopy. Pre- and post-operative wrist functions were evaluated using the modified Mayo wrist score. Results Arthroscopic diagnosis confirmed TFCC type I lesions in 30 cases and type II lesions in 10 cases. All the arthroscopic procedures of debridement and repair were successful except for one case with ring finger extensor tendon rupture, which was later confirmed and treated by open surgery. No other complications were noted. The average follow-up period was 11.6 months. According to the modified Mayo wrist score the results were rated as excellent in 21 cases, good in 13 cases, fair in 5 cases and poor in 1 case. The overall satisfactory rate was 85.0%. Patients' satisfaction rate was 97.5%. Conclusion Wrist arthroscopic diagnosis and treatment of TFCC lesions is safe and effective. The clinical outcome is reliable. It is a technique worth recommending.

关 键 词:关节镜 诊断 治疗结果 三角纤维软骨复合体 

分 类 号:R687.3[医药卫生—骨科学]

 

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