Shih Jui-Tien, Lee Hung-Maan, Tan Chuan-Ming
Department of Orthopaedic Surgery, Armed Forces Taoyuan General Hospital, Taiwan.
J Trauma. 2002 Nov;53(5):922-7. doi: 10.1097/00005373-200211000-00018.
Tears in the traumatic triangular fibrocartilage complex (TFCC) are generally caused by falling accidents with pronated, hyperextended wrists, or by distraction injuries that pull the ulnar side of the wrist out of place. Tears in the triangular fibrocartilage complex often appear in association with ulnar wrist pain and limited wrist function in work or sport. This study addressed the arthroscopic repair of peripheral tears in the TFCC, in a sample of 37 patients who were undergoing TFCC repair by wrist arthroscopy.
From September 1996 to February 1999, 37 patients underwent TFCC repair by wrist arthroscopy. The mean follow-up period was 25.6 months (range, 22-28 months), and the patients' average age was 21 years. The study included 30 men and 7 women. All patients had early peripheral TFCC tears and no wrist fractures. The inside-out method was used to repair the tears and the distal radioulnar joint was fixed for 6 weeks using a 2.0-mm Kirschner wire. After operation, patients were rehabilitated, reexamined, and followed up at the clinic. Complications were also recorded.
The results were graded with a Mayo Modified Wrist Score. Ten of the 37 wrists were rated excellent, 24 were good, and 3 were fair. Overall, 34 of 37 patients (92%) rated satisfactorily and returned to sporting or work activities. Four patients experienced mild pain during work or exercise. Although motion remained normal for these patients, grip strength on the affected hand was at least 72% of that on the other hand.
Arthroscopic repair of early peripheral tears of the triangular fibrocartilage complex is a satisfactory method of repair. The procedure can enhance patients' wrist function by relieving pain and increasing tolerance for work or sport.
创伤性三角纤维软骨复合体（TFCC）撕裂通常由手腕旋前、过度伸展的摔倒事故引起，或由将手腕尺侧拉出原位的牵张损伤所致。三角纤维软骨复合体撕裂常伴有尺侧腕部疼痛及工作或运动中腕部功能受限。本研究针对37例接受腕关节镜下TFCC修复术的患者，探讨TFCC周边撕裂的关节镜修复情况。
1996年9月至1999年2月，37例患者接受腕关节镜下TFCC修复术。平均随访期为25.6个月（范围22 - 28个月），患者平均年龄21岁。研究包括30名男性和7名女性。所有患者均为早期TFCC周边撕裂且无腕部骨折。采用由内向外法修复撕裂处，并用2.0毫米克氏针固定桡尺远侧关节6周。术后，患者在门诊进行康复、复查及随访。同时记录并发症情况。
结果采用Mayo改良腕关节评分进行分级。37例手腕中，10例评定为优，24例为良，3例为中。总体而言，37例患者中有34例（92%）评定满意并恢复运动或工作活动。4例患者在工作或运动时出现轻度疼痛。尽管这些患者的活动度仍正常，但患侧手的握力至少为另一侧的72%。
关节镜修复三角纤维软骨复合体早期周边撕裂是一种令人满意的修复方法。该手术可通过减轻疼痛和提高对工作或运动的耐受性来增强患者的腕部功能。
