摘要
目的探讨腕关节镜下治疗三角纤维软骨复合体(triangular fibrocartilage complex,TFCC)损伤的方法及疗效。方法 2006年1月-2008年12月,收治TFCC损伤16例。男11例,女5例;年龄25～51岁,平均32.5岁。扭伤12例,跌伤4例。左侧10例,右侧6例。病程3个月～6年2个月。主要临床症状为腕关节尺侧疼痛、无力,用力握拳和提重物时疼痛明显。尺腕应力试验阳性14例,阴性2例。术前腕关节掌屈(45.58±5.18)°,背伸(41.22±3.83)°,桡偏(17.82±2.48)°,尺偏(21.35±4.61)°,旋前(69.85±8.36)°,旋后(70.13±6.34)°。术中根据腕关节镜下观察情况,对损伤按照Palmer创伤性TFCC分类标准进行分类并行相应治疗。其中10例ⅠA类损伤行清理术;3例ⅠB类损伤中2例行缝合修补,1例缝合失败改部分切除术;2例ⅠC类损伤对损伤的三角软骨盘及尺月韧带和尺三角韧带进行清创;1例ⅠD类损伤采取汽化修整成形术。结果术后切口均Ⅰ期愈合,未发生关节感染及神经、血管损伤等并发症。患者均获随访,随访时间14～38个月,平均18.5个月。15例恢复正常生活、工作,无腕关节尺侧疼痛发生;1例无疼痛发生,但腕关节无力。末次随访时腕关节掌屈(50.16±6.21)°,背伸(45.37±4.65)°,桡偏(18.95±3.56)°,尺偏(26.28±5.09)°,旋前(78.87±7.69)°,旋后(76.46±8.31)°,与术前相应指标比较差异均有统计学意义(P<0.05)。采用Green-O’Brien功能评定方法进行评定,获优9例,良6例,可l例,优良率93.75%。结论 腕关节镜下治疗TFCC损伤既能明确诊断,又能进行相应处理,且创伤小,功能恢复快,可有效避免腕尺侧疼痛的发生。
Objective To evaluate the treatment and effects of wrist arthroscopy in tear of triangular fibrocartilage complex（TFCC）.Methods Between January 2006 and December 2008,16 patients with tear of TFCC were treated.Of 16 patients,11 were male and 5 were female with an average age of 32.5 years（range,25-51 years）.Injury was caused by sprain in 12 cases,and by falling in 4 cases.The locations were the left side in 10 cases and the right side in 6 cases.The mean injury duration was 3 months to 6 years and 2 months.The main clinical symptoms included wrist powerlessness and ulnar-sided wrist pain which was aggravated with clench fist and lifting heavy things.The results of the ulnar-sided wrist stress test were positive in 14 cases and negative in 2 cases.The preoperative values of wrist range of motion（ROM） were（45.58 ± 5.18）° at volar flexion,（41.22 ± 3.83）° at dorsal extension,（17.82 ± 2.48）° at radial deviation,（21.35 ± 4.61）° at ulnar deviation,（69.85 ± 8.36）° at pronation,and（70.13 ± 6.34）° at supination.According to Palmer standard,10 cases of IA were treated with debridement;3 cases of IB with suture and 1 of them failed and was partially excised;2 cases of IC with debridment on triangular fibrocartilage disc,ulnolunate ligament,and ulnotriguetrum ligament;and 1 case of ID with trimming plastic operation.Results All incisions healed by first intention,and no complications of joint infection or neurovascular injury was found.All patients were followed up 14-38 months（mean,18.5 months）.Fifteen patients were restored to normal life and work without ulnar-sided wrist pain.One patient had no pain,but he had wrist powerless.The values of ROM at last follow-up were（50.16 ± 6.21）° at volar flexion,（45.37 ± 4.65）° at dorsal extension,（18.95 ± 3.56）° at radial deviation,（26.28 ± 5.09）° at ulnar deviation,（78.87 ± 7.69）° at pronation,and（76.46 ± 8.31）° at supination;showing significant differences when compared with preoperative values（P 0.05）.According to Green-O’Brien standard,the results were excellent in 9 cases,good in 6 cases,fair in 1 case,and the execellent and good rate was 93.75%.Conclusion The wrist arthroscopy not only can definitely diagnose tear of TFCC,but also is useful for treatment.In addition,the incision is small and the function is easy to recover,and the occurence of chronic ulnar-sided wrist pain can be effectively avoided.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第1期5-8,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
三角纤维软骨复合体损伤
腕关节镜
修复
Triangular fibrocartilage complex tear Wrist arthroscopy Repair
