Yamamoto Michiro, Koh Shukuki, Tatebe Masahiro, Shinohara Takaaki, Shionoya Kaori, Hirata Hitoshi, Nakamura Ryogo
Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
J Orthop Sci. 2010 Mar;15(2):210-5. doi: 10.1007/s00776-009-1445-5. Epub 2010 Apr 1.
The present study evaluated the importance of visualizing both sides of the triangular fibrocartilage complex (TFCC) when diagnosing ulnar wrist pain.
A total of 20 patients with ulnar wrist pain who underwent both radiocarpal joint (RCJ) and distal radioulnar joint (DRUJ) arthroscopy were studied retrospectively. TFCC was graded as normal or as having wear or tear. The definitive diagnosis was made by evaluating the TFCC from both joints. The medical records were reviewed to document the preoperative diagnosis, arthroscopic findings, postoperative diagnosis, and operative procedure(s) performed after the arthroscopic examinations. The patients' status at final follow-up was evaluated using the modified Green and O'Brien wrist scoring system. The TFCC grading on RCJ and DRUJ arthroscopies was compared.
The final diagnosis was modified after arthroscopic examination in three cases (15%). In six patients (30%), DRUJ arthroscopy revealed pathological TFCC findings that could not be detected on RCJ arthroscopy. The DRUJ arthroscopy detected wear or degenerative changes seen only on the proximal aspect of the TFCC in four patients and tear in two patients. On the other hand, in only one patient (5%) were there no pathological findings observed from the DRUJ portal, although RCJ arthroscopy found wear. In eight patients (45%), the arthroscopic grading of TFCC was the same on RCJ and DRUJ arthroscopy; of these, the TFCC was graded as normal in one patient, showing wear in three patients, and with a tear in five patients. For diagnosing TFCC pathology, RCJ arthroscopy had a sensitivity of 68% and a negative predictive value (NPV) of 14%, whereas the sensitivity was 95% and the NPV was 50% for DRUJ.
Adding DRUJ arthroscopy to RCJ arthroscopy enables more accurate diagnosis of TFCC pathology because the proximal aspect of the articular disk and the foveal insertion of the distal radioulnar ligament can be visualized.
本研究评估了在诊断尺侧腕部疼痛时观察三角纤维软骨复合体（TFCC）两侧的重要性。
对20例接受桡腕关节（RCJ）和远侧桡尺关节（DRUJ）关节镜检查的尺侧腕部疼痛患者进行回顾性研究。TFCC被分为正常或有磨损或撕裂。通过从两个关节评估TFCC做出明确诊断。查阅病历以记录术前诊断、关节镜检查结果、术后诊断以及关节镜检查后进行的手术操作。使用改良的格林和奥布赖恩腕关节评分系统评估患者最后随访时的状况。比较RCJ和DRUJ关节镜检查时TFCC的分级。
3例患者（15%）在关节镜检查后最终诊断被修正。6例患者（30%）中，DRUJ关节镜检查发现了RCJ关节镜检查未检测到的TFCC病理表现。DRUJ关节镜检查在4例患者中检测到仅在TFCC近端出现的磨损或退行性改变，在2例患者中检测到撕裂。另一方面，尽管RCJ关节镜检查发现有磨损，但仅1例患者（5%）从DRUJ入路未观察到病理表现。8例患者（45%）中，RCJ和DRUJ关节镜检查时TFCC的关节镜分级相同；其中，1例患者TFCC分级为正常，3例患者显示有磨损，5例患者有撕裂。对于诊断TFCC病变，RCJ关节镜检查的敏感性为68%，阴性预测值（NPV）为14%，而DRUJ的敏感性为95%，NPV为50%。
在RCJ关节镜检查中增加DRUJ关节镜检查能够更准确地诊断TFCC病变，因为可以观察到关节盘的近端以及远侧桡尺韧带的中央凹附着处。
