Yao Jeffrey, Dantuluri Phani, Osterman A Lee
Stanford University Medical Center, Palo Alto, California 94304, USA.
Arthroscopy. 2007 Dec;23(12):1357.e1-4. doi: 10.1016/j.arthro.2007.02.010. Epub 2007 May 7.
Peripheral triangular fibrocartilage complex (TFCC) tears are amenable to repair. Limitations of current repair techniques include prolonged recovery and button or knot intolerance. We present a novel technique of an all-inside repair using existing technology (FasT-Fix; Smith & Nephew Endoscopy, Andover, MA) to circumvent these complications. This technique is faster, easily performed, safe, and potentially stronger than current repairs. Earlier motion and rehabilitation are instituted after this repair. The tear is debrided to stimulate angiogenesis. The FasT-Fix is inserted through the 3-4 portal with the arthroscope in the 6R portal. The first poly-L-lactic acid block is deposited peripheral to the tear. Upon penetration of the wrist capsule, a distinct decrease in resistance is felt. The introducer is withdrawn, depositing the block outside the capsule. The trigger on the introducer advances the second block into the deployment position. It is advanced and deposited central to the tear, forming a vertical mattress configuration. The introducer is removed, leaving the pre-tied suture. The knot is tightened and cut by use of the knot pusher/cutter. Multiple implants may be inserted to complete the repair. Postoperative care involves a sugartong splint for 2 weeks followed by a short arm cast for 4 weeks. Range of motion is begun thereafter with strengthening started at 10 weeks.
外周三角纤维软骨复合体（TFCC）撕裂适合进行修复。当前修复技术的局限性包括恢复时间长以及对纽扣或结的不耐受。我们提出一种使用现有技术（FasT-Fix；史赛克内窥镜公司，马萨诸塞州安多弗）进行全关节内修复的新技术，以规避这些并发症。该技术比当前的修复方法更快、操作简便、安全且可能更牢固。这种修复后可更早开始活动和康复。对撕裂部位进行清创以刺激血管生成。在关节镜位于6R入口的情况下，将FasT-Fix通过3-4入口插入。第一个聚-L-乳酸块放置在撕裂部位的周边。当穿透腕关节囊时，会感觉到阻力明显减小。拔出导引器，将块放置在囊外。导引器上的扳机将第二个块推进到展开位置。将其推进并放置在撕裂部位的中央，形成垂直褥式结构。取出导引器，留下预先系好的缝线。使用打结推压器/切割器收紧并剪断结。可插入多个植入物以完成修复。术后护理包括使用糖钳夹板固定2周，然后使用短臂石膏固定4周。此后开始活动范围训练，10周时开始加强锻炼。
