Wysocki Robert W, Richard Marc J, Crowe Matthew M, Leversedge Fraser J, Ruch David S
Rush University Medical Center, Chicago, IL 60612, USA.
J Hand Surg Am. 2012 Mar;37(3):509-16. doi: 10.1016/j.jhsa.2011.12.023. Epub 2012 Feb 2.
We describe a variant of triangular fibrocartilage complex (TFCC) tears in which the superficial fibers attaching to the ulnar capsule are torn, with preservation of deep fibers inserting on the fovea. We present the clinical and magnetic resonance imaging findings and the results of arthroscopic repair in patients with this injury.
Twenty-nine wrists were treated arthroscopically for peripheral TFCC tears with outside-in suture repair of the TFCC to the ulnar capsule. A retrospective review of all cases was performed to assess the physical examination, magnetic resonance imaging, and intraoperative findings. Patients were evaluated at greater than 1 year with range of motion, grip strength, standard outcome measures, and a survey assessing return to work and sports.
Before surgery, all patients had complaints of ulnar-sided wrist pain with a stable distal radioulnar joint on examination. Twenty-six wrists (90%) were available for follow-up at a mean of 31 months. There was one repeat surgery, a re-tear that required revision TFCC repair. The preoperative visual analog scale and Disabilities of the Arm, Shoulder, and Hand scores improved from 5 and 38 to 1 and 9, respectively, at final follow-up. Side-to-side comparisons demonstrated no measurable loss in motion or grip strength. There were no cases of distal radioulnar joint instability at final follow-up. Of 11 high-level athletes in the total cohort, 7 (64%) were able to return to sports, including all of those in racquet sports; however, athletes who bore weight through their hands were unable to return to their sporting activity.
Tears of the TFCC superficial fibers with the deep fibers intact present with ulnar-sided wrist pain but without distal radioulnar joint instability. The results of outside-in repair of the articular disk back to the ulnar capsule demonstrated improvement in pain and function with no measurable objective losses. Return to sport was variable and appeared worse for those who bear weight through the hands.
我们描述了一种三角纤维软骨复合体（TFCC）撕裂的变异类型，即附着于尺侧关节囊的浅层纤维撕裂，而插入凹部的深层纤维保持完整。我们展示了此类损伤患者的临床和磁共振成像结果以及关节镜修复的结果。
对29例腕关节进行关节镜下治疗，针对周围TFCC撕裂采用由外向内缝合将TFCC修复至尺侧关节囊。对所有病例进行回顾性分析，以评估体格检查、磁共振成像和术中发现。在1年以上对患者进行评估，包括活动范围、握力、标准结局指标，以及一项评估恢复工作和运动情况的调查。
术前，所有患者均主诉尺侧腕部疼痛，检查时远端桡尺关节稳定。26例腕关节（90%）可进行随访，平均随访时间为31个月。有1例再次手术，为再次撕裂，需要进行TFCC修复翻修。末次随访时，术前视觉模拟评分和上肢、肩部和手部功能障碍评分分别从5分和38分改善至1分和9分。双侧比较显示活动度或握力无明显下降。末次随访时无远端桡尺关节不稳定病例。在整个队列的11名高水平运动员中，7名（64%）能够恢复运动，包括所有从事球拍运动的运动员；然而，通过手部负重的运动员无法恢复其体育活动。
TFCC浅层纤维撕裂而深层纤维完整时，表现为尺侧腕部疼痛，但无远端桡尺关节不稳定。将关节盘由外向内修复至尺侧关节囊的结果显示疼痛和功能有所改善，且无明显客观功能损失。恢复运动的情况因人而异，对于通过手部负重的患者似乎更差。
