Mi Kun, Liu Wu, Liu Pengfei, Feng Zhibin, Li Yuwen, Hui Guisheng
Department of Orthopedic Trauma and Hand Surgery, No.1 Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning Guangxi, 530023, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Jan;25(1):5-8.
To evaluate the treatment and effects of wrist arthroscopy in tear of triangular fibrocartilage complex (TFCC).
Between January 2006 and December 2008, 16 patients with tear of TFCC were treated. Of 16 patients, 11 were male and 5 were female with an average age of 32.5 years (range, 25-51 years). Injury was caused by sprain in 12 cases, and by falling in 4 cases. The locations were the left side in 10 cases and the right side in 6 cases. The mean injury duration was 3 months to 6 years and 2 months. The main clinical symptoms included wrist powerlessness and ulnar-sided wrist pain which was aggravated with clench fist and lifting heavy things. The results of the ulnar-sided wrist stress test were positive in 14 cases and negative in 2 cases. The preoperative values of wrist range of motion (ROM) were (45.58 +/- 5.18) degrees at volar flexion, (41.22 +/- 3.83) degrees at dorsal extension, (17.82 +/- 2.48) degrees at radial deviation, (21.35 +/- 4.61) degrees at ulnar deviation, (69.85 +/- 8.36) degrees at pronation, and (70.13 +/- 6.34) degrees at supination. According to Palmer standard, 10 cases of IA were treated with debridement; 3 cases of IB with suture and 1 of them failed and was partially excised; 2 cases of IC with debridement on triangular fibrocartilage disc, ulnolunate ligament, and ulnotriguetrum ligament; and 1 case of ID with trimming plastic operation.
All incisions healed by first intention, and no complications of joint infection or neurovascular injury was found. All patients were followed up 14-38 months (mean, 18.5 months). Fifteen patients were restored to normal life and work without ulnar-sided wrist pain. One patient had no pain, but he had wrist powerless. The values of ROM at last follow-up were (50.16 +/- 6.21) degrees at volar flexion, (45.37 +/- 4.65) degrees at dorsal extension, (18.95 +/- 3.56) degrees at radial deviation, (26.28 +/- 5.09) degrees at ulnar deviation, (78.87 +/- 7.69) degrees at pronation, and (76.46 +/- 8.31) degrees at supination; showing significant differences when compared with preoperative values (P < 0.05). According to Green-O'Brien standard, the results were excellent in 9 cases, good in 6 cases, fair in 1 case, and the excellent and good rate was 93.75%.
The wrist arthroscopy not only can definitely diagnose tear of TFCC, but also is useful for treatment. In addition, the incision is small and the function is easy to recover, and the occurrence of chronic ulnar-sided wrist pain can be effectively avoided.
评估腕关节镜治疗三角纤维软骨复合体（TFCC）损伤的疗效。
2006年1月至2008年12月，对16例TFCC损伤患者进行治疗。16例患者中，男11例，女5例，平均年龄32.5岁（25 - 51岁）。损伤原因：扭伤12例，摔伤4例。左侧10例，右侧6例。平均损伤时间为3个月至6年2个月。主要临床症状为腕部无力及尺侧腕部疼痛，握拳及提重物时加重。尺侧腕部应力试验阳性14例，阴性2例。术前腕关节活动度（ROM）：掌屈（45.58±5.18）度，背伸（41.22±3.83）度，桡偏（17.82±2.48）度，尺偏（21.35±4.61）度，旋前（69.85±8.36）度，旋后（70.13±6.34）度。按Palmer标准，IA型10例行清创术；IB型3例行缝合术，其中1例失败后部分切除；IC型2例行三角纤维软骨盘、尺月韧带及尺三角韧带清创术；ID型1例行修整成形术。
所有切口均一期愈合，未发现关节感染及神经血管损伤等并发症。所有患者随访14 - 38个月（平均18.5个月）。15例患者恢复正常生活及工作，无尺侧腕部疼痛。1例患者无疼痛，但腕部仍无力。末次随访时ROM值：掌屈（50.16±6.21）度，背伸（45.37±4.65）度，桡偏（18.95±3.56）度，尺偏（26.28±5.09）度，旋前（78.87±7.69）度，旋后（76.46±8.31）度；与术前相比差异有统计学意义（P < 0.05）。按Green - O'Brien标准，优9例，良6例，可1例，优良率为93.75%。
腕关节镜不仅能明确诊断TFCC损伤，而且对其治疗有帮助。此外切口小，功能恢复快，能有效避免慢性尺侧腕部疼痛的发生。
