三角纤维软骨复合体损伤腕关节镜下修复的三维运动学研究  

Three-dimensional kinematics study of arthroscopic repair for triangular fibrocartilage complex injury

作　　者：刘佳佳[1] 谢仁国[3] 邢树国 王古衡 茅天 

机构地区：[1]南通大学附属医院急诊外科,江苏南通226001 [2]南通大学附属医院手外科,江苏南通226001 [3]上海市第一人民医院骨科

出　　处：《中华手外科杂志》2018年第1期44-48,共5页Chinese Journal of Hand Surgery

基　　金：国家自然科学基金项目（81371948）;南通市科技项目（MS22015120）

摘　　要：目的通过三维运动学评价三角纤维软骨复合体（mangular fibrocartilage complex，TFCC）ⅠB型损伤关节镜下修复方法对桡尺远侧关节（distal radioulnar joint，DRUJ）稳定性的恢复效果。方法选用6例新鲜冰冻上肢标本建立TFCCIB型损伤模型，采用TFCC-骨隧道固定技术进行关节镜下修复。对TFCC损伤前、损伤后、修复后的腕关节标本进行6种不同旋转位置及中立位的CT扫描。通过三维重建分别测量标记点在TFCC损伤前、损伤后及修复后腕关节不同旋转位置相对中立位的移位距离，从而评价DRUJ的稳定性。结果在腕关节旋前至旋后的过程中，TFCC损伤前尺桡骨接触点由背侧向掌侧移动，而尺骨小凹由掌侧向背侧移动。TFCC损伤后两个标记点的位移均增大；TFCC修复后标记点的位移缩小且与TFCC损伤前相比差异无统计学意义。结论腕关节镜下TFCC-骨隧道固定技术修复TFCCIB型损伤可恢复DRUJ的稳定性。Objective To evaluate the effect of arthroscopic repair for triangular fibrocartilage complex （TFCC） type IB injury on the stability of distal radioulnar joint （DRUJ） by the three-dimensional kinematics. Methods Six cases of fresh frozen upper limb specimens were used to establish TFCC type IB injury model. TFCC-bone tunnel fixation technique was used for arthroscopic repair. CT scans of 6 different rotation positions and neutral position were performed on the wrist specimens before and after TFCC injury or after TFCC repair. Three-dimensional reconstruction was used to measure the shift distance of wrist marker points at different rotation positions before and after TFCC injury or after TFCC repair relative to neutral position, respectively. And the stability of DRUJ was evaluated. Results In the process of wrist pronation and supination, the ulna and radius contact site moved from the dorsal side to the volar side before TFCC injury, while the ulna fovea moved from the volar side to the dorsal side. The displacement of the two markers increased after TFCC injury. After TFCC repair, the displacement of marker points was reduced and there was no significant difference compared with that before TFCC injury. Conclusion The stability of DRUJ can be restored by TFCC-bone tunnel fixation under wrist arthroseopy for repair of TFCC type IB injury.

关 键 词：三角纤维软骨 关节镜 桡尺远侧关节稳定性 三维运动学 

分 类 号：R687.4[医药卫生—骨科学]