腕关节镜下透骨足印修复技术治疗三角纤维软骨复合体损伤的疗效  

Efficacy of wrist arthroscopic transosseous footprint repair technique for the treatment of triangular fibrocartilage complex injury

作　　者：赵喆[1] 耿红荔 刘建全[1] 李永胜[1] 尹建文 程翔宇 陈小强 王光辉[1] 李嘉贝 邓志钦 王满宜[3] 李文翠[1] Zhao Zhe;Geng Hongli;Liu Jianquan;Li Yongsheng;Yin Jianwen;Cheng Xiangyu;Chen Xiaoqiang;Wang Guanghui;Li Jiabei;Deng Zhiqin;Wang Manyi;Li Wencui(Department of Foot-Ankle&Hand Surgery,Shenzhen Second People′s Hospital(First Affiliated Hospital of Shenzhen University),Shenzhen 518035,China;Department of Rehabilitation,Shenzhen Second People′s Hospital(First Affiliated Hospital of Shenzhen University),Shenzhen 518035,China;Department of Traumatic Orthopedics,BeiJing Ji Shuitan Hospital,Beijing 100085,China)

机构地区：[1]深圳市第二人民医院(深圳大学第一附属医院)足踝外科-手外科,深圳518035 [2]深圳市第二人民医院(深圳大学第一附属医院)康复科,深圳518035 [3]北京积水潭医院创伤骨科,北京100085

出　　处：《中华创伤杂志》2022年第8期714-720,共7页Chinese Journal of Trauma

摘　　要：目的探讨腕关节镜下透骨足印修复技术治疗三角纤维软骨复合体(TFCC)损伤的临床疗效。方法采用回顾性病例系列研究分析2017年7月至2020年9月深圳市第二人民医院收治的56例TFCC损伤患者的临床资料, 其中男38例, 女18例;年龄17~45岁[(33.5±3.6)岁]。均为单侧损伤。体检示下尺桡关节不稳定, MRI及关节镜下证实为TFCC深层韧带损伤。患者均接受腕关节镜下透骨足印修复TFCC深层止点。记录手术时间、术中出血量、伤口愈合情况及术后并发症情况;比较术前、术后3个月及术后1年患侧腕关节屈伸、尺桡偏及前臂旋转活动度、患者自行评估量表(PRWE)评分、改良Mayo腕关节功能评分、视觉模拟评分(VAS)及患侧与健侧握力百分比。结果患者均获随访12~18个月[(13.4±5.2)个月]。手术时间为(61.3±8.9)min;术中出血量为(2.4±1.2)ml。所有伤口Ⅰ期愈合。术后无一例患者出现伤口感染或尺神经激惹症状。4例患者术后短期内腕尺侧有弹响, 均自行消失。术后3个月腕关节尺桡偏活动度由术前(52.5±5.9)°降至(42.6±5.9)°, 前臂旋转活动度由术前(94.9±8.4)°降至(84.6±5.9)°(P均<0.01), 但屈伸活动度术前[(93.1±17.4)°]与术后3个月[(89.4±5.8)°]差异无统计学意义(P>0.05);与术后3个月比较, 术后1年腕关节屈伸活动度提高至(101.3±13.6)°, 尺桡偏活动度提高至(52.4±6.6)°, 前臂旋转活动度提高至(116.4±16.4)°(P均<0.01)。术后3个月PRWE评分由术前(10.6±3.2)分提高至(17.1±3.8)分(P<0.01), 改良Mayo腕关节功能评分由术前(78.1±12.7)分降至(70.3±6.7)分(P<0.01), VAS由术前(6.2±1.5)分降至(4.4±1.7)分(P>0.05), 患侧与健侧握力百分比由术前(74.4±15.2)%降至(55.7±8.7)%(P<0.01);与术后3个月比较, 术后1年PRWE评分降至(2.0±0.9)分, 改良Mayo腕关节功能评分提高至(94.8±3.3)分, VAS降至(2.1±1.1)分, 患侧与健侧握力百分比提高至(93.2±8.7)%(P均<0.01)。结论腕关Objective To investigate the clinical efficacy of wrist arthroscopic transosseous footprint repair technique for treating triangular fibrocartilage complex(TFCC)injury.Methods A retrospective case series study was conducted to analyze the clinical data of 56 patients with TFCC injury admitted to Shenzhen Second People′s Hospital from July 2017 to September 2020,including 38 males and 18 females,aged 17-45 years[(33.5±3.6)years].All patients had unilateral injury.Physical examination showed instability of the distal radioulnar joint,and MRI and arthroscopy confirmed deep ligament injury of TFCC.All patients underwent repair of deep insertion of the TFCC by using wrist arthroscopic transosseous footprint.The operation time,intraoperative blood loss,wound healing and postoperative complications were recorded.The flexion and extension range of motion of the wrist,radial and ulnal deviation of the wrist,rotation range of motion of the forearm,patient related wrist evaluation(PRWE)score,modified Mayo wrist score,visual analogue scale(VAS),and percentage of grip strength between the affected side and unaffected side were compared preoperatively,at 3 months postoperatively and at 1 year postoperatively.Results All patients were followed up for 12-18 months[(13.4±5.2)months].The operation time was(61.3±8.9)minutes,with the intraoperative blood loss of(2.4±1.2)ml.All wounds were healed by first intension.There was no wound infection or ulnar nerve irritation symptom after operation.Four patients experienced clicking on the ulnar side of the wrist in a short period of time post-operation,with spontaneous disappearance of the symptom.At 3 months postoperatively,the radial and ulnar deviation of the wrist was decreased from(52.5±5.9)°preoperatively to(42.6±5.9)°,and rotation range of motion of the forearm was decreased from(94.9±8.4)°preoperatively to(84.6±5.9)°(all P<0.01).The flexion and extension range of motion of the wrist was(93.1±17.4)°preoperatively,with insignificant difference compared with(89.4±5.8

关 键 词：腕损伤 关节镜检查 三角纤维软骨 

分 类 号：R687.4[医药卫生—骨科学]