Pilný M, Kubes T, Cizmár I, Jindra M, Sprláková A
Ortopedické oddelení Krajské nemocnice Pardubice.
Acta Chir Orthop Traumatol Cech. 2007 Aug;74(4):258-61.
The triangular fibrocartilaginous complex (TFCC) can be injured either due to trauma or by chronic strain. Based on these findings, Palmer devised a classification system distinguishing traumatic (I) and degenerative (II) TFCC lesions. Traumatic TFCC injury may be single or involved in a combined injury of the distal radius. The aim of this study was to evaluate the results of surgical treatment in patients with traumatic TFCC injury at six-month follow-up.
In the years 2000 to 2004, 23 patients with injury to the wrist were treated. The group comprised 16 men and 7 women at an average age of 34 years (range, 17 to 54 years). Nine patients were diagnosed with a distal radial fracture and 14 had no damage to the bony structures. Of these, seven showed clinical signs of TFCC injury and were indicated to acute arthroscopy of the wrist. The remaining seven, due to persisting complaints, were examined by arthroscopy within 3 months of injury. During the arthroscopic procedure, the Palmer type of injury was identified and arthroscopic treatment, open or closed, was carried out at the same stage. All patients were followed up for 6 months for pain relief and return to full physical activity.
The arthroscopic examination revealed the following TFCC lesions: 11 central ruptures (I.A), 6 ulnar tears (I.B), 4 palmar (I.C) and 2 radial (I.D) avulsions. During arthroscopy, partial resection of the disc was performed in 13 cases (I.A, I.D), and reattachment of the disc to the styloid process of the ulna was carried out in six cases (I.B). In four of these patients the intervention was done at the stage of acute lesion within 4 weeks of injury, and in two within a longer period. Four patients with type I.C injuries underwent open disc reattachment from the palmar approach. Subjective evaluation showed that 65 % of the patients had no complaints, 26 % reported pain after excessive activity and 9 % had pain associated with daily activities. Nome of the patients reported rest pain.
In our group, 91 % of the patients reported excellent and very good results at six months of follow-up. The two patients experiencing pain in daily activities (9 %) had type I.B. injury and were indicated for arthroscopy at a time longer than 6 weeks after injury.
TFCC lesions are wrist injuries which, if diagnosed early and treated appropriately, show good healing. If the triangular fibrocartilage complex is damaged by a central tear, disc resection gives good results. However, if the distal radioulnar ligaments are torn, their reattachment is necessary in order to prevent instability of the distal radioulnar joint. Open surgical procedures interfere with integrity of the distal radioulnar joint ligaments, which may lead to joint instability and prolonged healing.
三角纤维软骨复合体（TFCC）可因外伤或慢性劳损而受损。基于这些发现，帕尔默设计了一种分类系统，以区分创伤性（I型）和退行性（II型）TFCC损伤。创伤性TFCC损伤可能是单一的，也可能合并桡骨远端损伤。本研究的目的是评估创伤性TFCC损伤患者在术后6个月随访时的手术治疗效果。
2000年至2004年期间，对23例腕部损伤患者进行了治疗。该组包括16名男性和7名女性，平均年龄34岁（范围17至54岁）。9例患者被诊断为桡骨远端骨折，14例患者的骨结构未受损。其中，7例表现出TFCC损伤的临床体征，接受了腕关节急性关节镜检查。其余7例因持续存在不适症状，在受伤后3个月内接受了关节镜检查。在关节镜检查过程中，确定帕尔默损伤类型，并在同一阶段进行开放或闭合的关节镜治疗。所有患者均随访6个月，观察疼痛缓解情况及恢复完全体力活动的情况。
关节镜检查发现以下TFCC损伤：11例中央撕裂（I.A型），6例尺侧撕裂（I.B型），4例掌侧（I.C型）和2例桡侧（I.D型）撕脱。在关节镜检查期间，13例（I.A型、I.D型）进行了部分椎间盘切除术，6例（I.B型）进行了椎间盘重新附着于尺骨茎突的手术。其中4例患者在受伤后4周内的急性损伤阶段进行了干预，2例在更长时间后进行。4例I.C型损伤患者采用掌侧入路进行了开放椎间盘重新附着手术。主观评估显示，65%的患者无不适症状，26%的患者报告在过度活动后疼痛，9%的患者报告与日常活动相关的疼痛。没有患者报告静息痛。
在我们的研究组中，91%的患者在随访6个月时报告了优秀和非常好的结果。2例在日常活动中疼痛的患者（9%）为I.B型损伤，在受伤后6周以上的时间接受了关节镜检查。
TFCC损伤是腕部损伤，如果早期诊断并适当治疗，愈合良好。如果三角纤维软骨复合体因中央撕裂而受损，椎间盘切除术效果良好。然而，如果桡尺远侧韧带撕裂，则需要重新附着以防止桡尺远侧关节不稳定。开放手术会干扰桡尺远侧关节韧带的完整性，这可能导致关节不稳定和愈合时间延长。
