腕关节镜对三角纤维软骨复合体损伤的诊断和治疗价值分析

摘要

目的 对腕关节三角纤维软骨复合体(TFCC)损伤行关节镜检查,并分析其疗效.方法 对2006年1月至2009年12月诊断为TFCC损伤并行腕关节镜治疗的15例患者进行回顾性分析,其中男6例、女9例,平均年龄42岁,平均随访时间26.5个月.根据Palmer分型,Ⅰ型损伤5例(ⅠA型3例,ⅠB型1例,ⅠD型1例),Ⅱ型损伤10例(ⅡA型6例,ⅡC型4例).所有患者保守治疗3个月以上无效后行关节镜治疗.测量指标:腕关节疼痛、握力、关节活动度、腕关节评分(改良Mayo评分)、DASH问卷.结果 术后15例患者腕关节疼痛均有缓解,握力改善;腕关节屈伸(129±26)°,桡尺偏(40±8)°,旋转(174±11)°.按照改良Mayo评分:优3例,良8例,可4例;优良率为73%.术后DASH评分为4～28分,平均(15±7)分.结论 关节镜对于TFCC损伤的诊断明显优于MRI检查,而且关节镜能在检查的同时进行治疗,应作为腕尺痛的常规诊断手段.关节镜治疗各型TFCC损伤均能缓解疼痛,但Ⅰ型效果好于Ⅱ型.伴有尺骨正变异的TFCC损伤应同时行尺骨缩短术以提高术后效果.%Objective The objective of this study was to determine the efficiency of arthroscopic diagnosis and repair of triangular fibrocartilage complex (TFCC) tears. Methods Fifteen cases of TFCC tears diagnosed and treated with arthroscopic repair in our hospital between January 2006 and December 2009 were retrospectively reviewed. There were six males and nine females. The average age was 42 years. The average follow-up was 26.5 months. TFCC tears were classified by Palmer classification as follows:ⅠA (3 cases),ⅠB (1 case),ⅠD (1 case),ⅡA (6 cases),and ⅡC (4 cases). Arthroscopic repair was performed after at least 3 months of conservative treatment failed. Wrist pain,grip strength,range of motion (ROM),wrist score (modified Mayo wrist score),disabilities of the arm,shoulder,and hand questionnaire (DASH) score were evaluated. Results Postoperatively alleviation of pain and improved grip strength was noted in all 15 patients. ROM averaged (129±26)° for the extension/flexion arc,(40±8)° for the radial/ulnar deviation arc,and (174±11)° for the pronation/supination arc of motion. The good-to-excellent rate of modified Mayo wrist score was 73% (excellent in 3 of patients,good in 8,fair in 4,and poor in 0). The average DASH score was 15±7 (range,4 to 28). Conclusion Standard arthroscopic procedure is more efficient in the diagnosis of TFCC injury than MRI. The advantage of simultaneous repair makes arthroscopic examination a normal procedure for patients with ulnar wrist pain. The outcome of type Ⅰ is better than type Ⅱ,although pain relief is obtained in each form of TFCC injuries after arthroscopic repair. In cases associated with marked positive ulnar variance,the simultaneous use of primary ulna-shortening osteotomy leads to promising results.