腕关节镜下经骨缝合修复慢性TFCC隐窝撕裂的疗效分析  

Analysis of the clinical efficacy of arthroscopy-assisted transosseous repair of chronic triangular fibrocartilage complex foveal tears

作　　者：曹文亮 赵玲珑 郑文 于学军 向胜涛 安伟 杨波 王倩 呼娜 滕云升 Cao Wenliang;Zhao Linglong;Zheng Wen;Yu Xuejun;Xiang Shengtao;An Wei;Yang Bo;Wang Qian;Hu Na;Teng Yunsheng(Department of Hand Surgery,521 Hospital of Norinco Group,Xi′an 710065,China;Department of Medical Office,521 Hospital of Norinco Group,Xi′an 710065,China)

机构地区：[1]西安市兵器工业五二一医院手外二科,西安710065 [2]西安市兵器工业五二一医院医务处,西安710065

出　　处：《中华手外科杂志》2024年第1期73-77,共5页Chinese Journal of Hand Surgery

摘　　要：目的探讨腕关节镜下直接经骨缝合修复慢性三角纤维软骨复合体(triangular fibrocartilage complex,TFCC)隐窝撕裂的疗效。方法自2018年3月至2022年9月,我科对9例病程均大于6个月的慢性TFCC隐窝撕裂患者采用腕关节镜下经骨直接缝合修复,术中针对合并的Palmer 1A或1D型损伤采用刨刀清理边缘后再用等离子电凝行热皱缩。术后定期复查。采用VAS评分、PRWE评分、活动度及握力作为评价指标。对比末次随访结果与术前结果。结果术后9例患者均获得随访,时间12~36个月,平均(25.0±8.3)个月。末次随访时VAS评分、PRWE评分、握力及前臂旋转度均较术前改善,差异有统计学意义;腕关节屈伸度较术前略有下降,但差异无统计学意义;均无桡尺远侧关节不稳定及手术相关并发症。结论对于病程大于6个月的TFCC隐窝撕裂,镜检见TFCC质量良好时,术中仔细清理撕裂端,直接经骨缝合修复仍可恢复桡尺远侧关节稳定性,获得满意疗效。Objective To investigate the feasibility and efficacy of arthroscopy-assisted transosseous repair for chronic triangular fibrocartilage complex(TFCC)foveal tears.Methods From March 2018 to September 2022,our department used wrist arthroscopy to repair chronic TFCC foveal tears in 9 patients with a disease course of more than 6 months.During the surgery,for combined Palmer 1A or 1D type injuries,a planer was used to clean the edges and then plasma electrocoagulation was performed for thermal shrinkage.The postoperative follow-up was conducted regularly.The VAS score,PRWE score,active motion and grip strength was set as evaluation indicators.The last follow-up results were compared with preoperative results.Results All 9 patients were follow-up for a period of 12 to 36 months,with an average of(25.0±8.3)months.At the last follow-up,VAS score,PRWE score,grip strength,and forearm rotation all improved compared to preoperative,and the differences were statistically significant.The wrist joint flexion and extension slightly decreased compared to preoperative,but the difference was not statistically significant.There were no unstable distal radioulnar joints or surgical related complications.Conclusion For TFCC foveal tears with a disease course greater than 6 months,when the quality of TFCC is good on microscopic examination,careful cleaning of the tear end during surgery and direct bone suture repair can still restore the stability of the distal radioulnar joint,achieving satisfactory clinical efficacy.

关 键 词：腕关节 关节镜 三角纤维软骨复合体 桡尺远侧关节 修复 

分 类 号：R687.4[医药卫生—骨科学]