腕关节镜下经骨隧道修复三角纤维软骨复合体损伤  

Arthroscopic one-tunnel transosseous foveal repair for triangular fibrocartilage complex peripheral tear

作　　者：张闻[1] 刘生和[1] 柴益民[1] 孙鲁源[1] ZHANG Wen;LIU Shenghe;CHAI Yimin;SUN Luyuan(Department of Orthopaedics,Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院骨科

出　　处：《国际骨科学杂志》2019年第6期357-363,共7页International Journal of Orthopaedics

摘　　要：目的评价经尺骨小凹单一骨隧道修复三角纤维软骨复合体(TFCC)周围部损伤的临床疗效。方法回顾性分析2013年7月至2016年12月上海交通大学附属第六人民医院骨科32例关节镜下经尺骨小凹修复TFCC的患者病例资料。其中男24例,女16例;年龄29.8±13.5岁(22~62岁);受伤至手术时间5.7±8.5个月(2~30个月)。术前通过下尺桡关节(DRUJ)冲击试验、MRI影像学表现及关节镜术中拉钩试验明确TFCC深层韧带在尺骨小凹止点处的损伤,采用经尺骨小凹单一骨隧道方法修复TFCC。术后给予过肘长臂石膏托前臂旋转中立位固定,4周后开始主动活动度训练,可拆卸支具保护腕关节3周。比较术前和末次随访时的疼痛视觉模拟评分(VAS)、握力、关节活动度、改良Mayo腕关节功能评分及上肢功能障碍评定量表(DASH)评分。结果术中关节镜检查发现,32例患者均为尺骨小凹处撕裂的Palmer 1B型TFCC周围部损伤,其中26例为TFCC深层撕裂(Atzei-EWAS 3型),6例为TFCC深层和浅层同时撕裂(Atzei-EWAS 2型)。32例患者均获得随访,随访时间24~42个月,平均(31.0±4.9)个月。末次随访时评估,24例患者DRUJ稳定性恢复正常,8例为DRUJ稳定性1级。腕关节屈伸活动度术前(126.4°±20.5°)与术后(135.4°±27.0°)无差异(P=0.140),桡偏/尺偏由术前的36.7°±10.7°提高至术后的40.0°±10.6°(P=0.039),前臂旋前/旋后活动度由术前的137.9°±29.1°提高至术后的148.6°±21.4°(P=0.031)。末次随访时,握力为(23.5±8.5)kg,VAS为(1.2±1.0)分,改良Mayo腕关节功能评分为(83.9±11.6)分,DASH评分为(10.4±6.5)分,均较术前显著改善[(20.6±8.3)kg,(3.7±1.2)分,(67.4±11.2)分,(34.6±10.2)分,(P均<0.05)]。术中无医源性尺骨远端骨折发生,术后无感染及尺神经手背支损伤发生。所有患者重返工作岗位,均恢复正常日常生活。结论腕关节镜下经尺骨小凹单一骨隧道修复TFCC尺骨小凹处撕裂,可有效缓解患者的关节疼�Objective The purpose of this study was to evaluate the clinical result of arthroscopic one-tunnel transosseous foveal repair for peripheral triangular fibrocartilage complex(TFCC)tears.Methods A retrospective study was conducted in the department of orthopeadics,Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University to analyze the clinical data of 32 patients who underwent arthroscopic transosseous TFCC foveal repair from July 2013 to December 2016.There were 24 males and 16 females,with an average of 29.8±13.5(range,22 to 62)years.The mean interval from injury to surgery was 5.7±8.5 months(range,2 to 30 months).The patients were diagnosed as a foveal tear of the TFCC based on the foveal sign,ballottement test,MRI imaging,and hook test during the arthroscopic examination.The torn TFCC of all patients was repaired with the arthroscopic one-tunnel transosseous foveal repair technique.Postoperative outcomes were evaluated using the visual analogue scale(VAS)for pain,wrist range of motion,grip strength,Mayo wrist score,Quick Disabilities of the Arm,Shoulder and Hand(Quick DASH)score,and postoperative complications.Results All patients were followed up for 24 to 42 months,with an average of 31.0±4.9 months.Arthroscopic examination revealed an isolated proximal component TFCC tear(Atzei-EWAS class 3)in 26 patients and a complete TFCC tear(Atzei-EWAS class 2)in 6 patients.At the final follow-up,the DRUJ instability test showed improved stability in all patients(grade 0 in 24 patients and grade 1 in 8 patients).The mean arcs of flexion-extension,radioulnar deviation,and pronation-supination at the final follow-up were 135.4°±27.0°,40.0°±10.6°and 148.6°±21.4°,respectively.The flexion-extension(P=0.140)arcs did not change significantly,whereas the radioulnar deviation(P=0.039)and range of forearm pronation-supination increased significantly(P=0.031)compared with preoperative measurements.Grip strength improved from preoperative 20.6±8.3 kg to postoperative 23.5±8.5 kg(P=0.032).Resting

关 键 词：三角纤维软骨 下尺桡关节 关节镜检查 修复外科手术 

分 类 号：R68[医药卫生—骨科学]