关节镜下三种技术修复腕三角纤维软骨复合体比较  

Comparison of three arthroscopic techniques for repair of wrist triangular fibrocartilage complex tear

作　　者：魏本磊 张玉[1] 赵铜林 栗威[1] WEI Ben-lei;ZHANG Yu;ZHAO Tong-lin;LI Wei(Affiliated Hospital,Jining Medical College,Jining,Shandong 272029,China;Jining Medical College,Jining,Shandong 272067,China)

机构地区：[1]济宁医学院附属医院,山东济宁272029 [2]济宁医学院,山东济宁272067

出　　处：《中国矫形外科杂志》2025年第1期19-24,共6页Orthopedic Journal of China

基　　金：济宁市重点研发计划项目(编号:2021YXNS115;2024YXNS088);济医附院医学英才培养计划项目(编号:2022-YXYC-011)。

摘　　要：[目的]比较腕关节镜下关节囊缝合(capsule suture,CS),穿单骨道(single bone tunnel,SBT)及Y形双骨道(double bone tunnels,DBT)三种技术修复三角纤维软骨复合体(triangular fibrocartilage complex,TFCC)Palmer IB型损伤的临床疗效。[方法]回顾性分析2014年6月—2023年9月本院采用关节镜治疗的49例TFCC IB型损伤患者的临床资料。依据术前医患沟通结果,将患者分为三组,14例采用CS,19例采用SBT,16例采用DBT。比较三组围手术期、随访及影像结果。[结果]三组患者均顺利完成手术。CS组手术时间[(106.5±15.4)min vs(170.6±15.7)min vs(163.1±19.2)min,P<0.001]和术中失血量[(14.0±3.5)ml vs(50.1±15.8)ml vs(46.7±13.4)ml,P<0.001]显著优于SBT组及DBT组,但CS组后外固定时间显著长于SBT组及DBT组[(50.1±6.1)d vs(33.6±7.2)d vs(31.9±4.8)d,P<0.001]。随访(14.0±5.6)个月,CS组完全负重活动时间显著晚于SBT组和DBT组[(55.8±3.1)d vs(45.1±3.3)d vs(37.5±5.5)d,P<0.001]。与术前相比,末次随访时三组患者VAS评分、Mayo评分、伸-屈ROM、尺偏-桡偏ROM、旋前-旋后ROM均显著改善(P<0.05)。末次随访时,SBT组VAS评分、尺偏-桡偏ROM显著优于DBT组(P<0.05),DBT组显著优于CS组(P<0.05)。DBT组Mayo评分、伸-屈ROM、旋前-旋后ROM显著优于SBT组(P<0.05),SBT组显著优于CS组(P<0.05)。影像方面,与术前相比,末次随访时三组患者尺-桡间距、TFCC连续性和尺桡隐窝水肿均显著改善(P<0.05)。末次随访时,DBT组上述影像指标均显著优于SBT组(P<0.05),SBT组显著优于CS组(P<0.05)。[结论]腕关节镜辅助双骨道固定修复TFCC损伤(IB型)安全有效,优于穿单骨道及关节囊修复技术。[Objective]To compare the clinical consequence of capsular suture(CS),single bone tunnel repair(SBT)and Y-shaped dou⁃ble bone tunnels repair(DBT)of Palmer type IB wrist triangular fibrocartilage complex(TFCC)tear.[Methods]A retrospective research was conducted on 49 patients who had Palmer type IB TFCC tear repaired arthroscopically in our hospital from June 2014 to September 2023.According to the preoperative doctor-patient communication,the patients were divided into three groups.Of them,14 patients re⁃ceived CS,19 received SBT,and 16 cases received DBT.The perioperative period,follow-up and imaging data of the three groups were com⁃pared.[Results]All patients in the 3 groups were operated on successfully.The CS group was significantly superior to the SBT and DBT groups in terms of operation time[(106.5±15.4)min vs(170.6±15.7)min vs(163.1±19.2)min,P<0.001]and intraoperative blood loss[(14.0±3.5)ml vs(50.1±15.8)ml vs(46.7±13.4)ml,P<0.001],whereas the CS group took significantly longer external fixation time than the SBT group and DBT group[(50.1±6.1)days vs(33.6±7.2)days vs(31.9±4.8)days,P<0.001].All of them were followed up for(14.0±5.6)months in a mean,and the CS group resumed full weight-bearing activity significantly later than the SBT and DBT groups[(55.8±3.1)days vs(45.1±3.3)days vs(37.5±5.5)days,P<0.001].The VAS score,Mayo score,extension-flexion ROM,ulnar-radial deviation ROM and pronation-su⁃pination ROM were significantly improved in three groups over time(P<0.05).At the last follow-up,the SBT group were significantly better than the DBT group in VAS score and ulnar-radial deviation ROM(P<0.05),while the DBT group was significantly superior to the SBT group in terms of Mayo score,extension-flexion ROM and pronation-supination ROM(P<0.05).Moreover,both DBT and SBT groups were significantly better than CS group regarding abovesaid items(P<0.05).As for imaging,the radioulnar distance,TFCC continuity and radioulnar recess edema were significantly improved in all the three groups at the

关 键 词：三角纤维软骨复合体损伤 腕关节镜 经骨固定 缝合 

分 类 号：R687[医药卫生—骨科学]