Estrella Emmanuel P, Hung Leung-Kim, Ho Pak-Cheong, Tse Wing Lam
Department of Orthopedics, Philippine General Hospital, Manila, Philippines.
Arthroscopy. 2007 Jul;23(7):729-37, 737.e1. doi: 10.1016/j.arthro.2007.01.026.
The objective of this study was to investigate the clinical results and functional outcomes of patients with peripheral triangular fibrocartilage complex (TFCC) lesions repaired by arthroscopic technique and to describe the pathology of dorsal tears of the TFCC, which was not described in Palmer's classification.
Thirty-five patients with arthroscopic repair of TFCC tears were reviewed. There were 22 males and 13 females. The average age was 33 years (range, 13 to 51 years). The average follow-up was 39 months (range, 4 to 82 months). TFCC tears were classified by the Palmer classification as follows: IB (11), IC (5), and ID (1). The remaining 18 were not classified according to the Palmer classification. Functional results were evaluated using the ADL (activities of daily living) score and the Modified Mayo Wrist Score.
A dorsal peripheral tear found in 18 wrists does not fulfill the Palmer classification of traumatic TFCC injuries. Seventy-four percent of patients had reduction in pain after surgery, with improvement in grip strength and daily activities (P < .05). The Modified Mayo Wrist score was excellent in 54%, good in 20%, fair in 12%, and poor in 14%. Nineteen of 28 working patients returned to their original work. Ulnar nerve dorsal branch neuritis occurred in 17%. A "second-look" arthroscopy was performed on 9 patients with healing shown in 7. Additional procedures were performed on 10 patients (29%) to improve functional outcome.
Arthroscopic repair of peripheral TFCC tears can provide satisfactory results. Seventy-four percent of our patients achieved good to excellent results, had significant pain relief, had increased grip strength, and had an increased capacity to perform daily activities. The Palmer classification does not completely classify all peripheral TFCC tears.
Level IV, therapeutic case series.
本研究的目的是调查经关节镜技术修复的外周三角纤维软骨复合体（TFCC）损伤患者的临床结果和功能预后，并描述TFCC背侧撕裂的病理情况，这在帕尔默分类中未作描述。
回顾了35例行关节镜下TFCC撕裂修复术的患者。其中男性22例，女性13例。平均年龄33岁（范围13至51岁）。平均随访39个月（范围4至82个月）。TFCC撕裂根据帕尔默分类如下：IB型（11例），IC型（5例），ID型（1例）。其余18例未按帕尔默分类。使用日常生活活动（ADL）评分和改良梅奥腕关节评分评估功能结果。
18例腕关节中发现的背侧外周撕裂不符合创伤性TFCC损伤的帕尔默分类。74%的患者术后疼痛减轻，握力和日常活动得到改善（P <.05）。改良梅奥腕关节评分优秀者占54%，良好者占20%，中等者占12%，差者占14%。28例工作患者中有19例恢复原工作。尺神经背支神经炎发生率为17%。对9例患者进行了“二次”关节镜检查，其中7例显示愈合。对10例患者（29%）进行了额外手术以改善功能预后。
关节镜下修复外周TFCC撕裂可提供满意的结果。我们74%的患者取得了良好至优秀的结果，疼痛明显减轻，握力增加，日常活动能力增强。帕尔默分类并未完全涵盖所有外周TFCC撕裂。
IV级，治疗性病例系列。
