Mrkonjic Ante, Geijer Mats, Lindau Tommy, Tägil Magnus
Department of Hand Surgery, Lund University and Skåne University Hospital, Sweden.
J Hand Surg Am. 2012 Aug;37(8):1555-60. doi: 10.1016/j.jhsa.2012.05.032.
To evaluate the long-term results of a prospective, longitudinal case series of untreated, traumatic triangular fibrocartilage complex (TFCC) tears found in displaced distal radial fractures.
Between 1995 and 1997, 51 patients (24 men, 27 women; age, 20-57 y) with a displaced distal radius fracture had wrist arthroscopy to identify associated injuries. Forty-three patients had complete or partial tears of the TFCC, which were not treated. All patients were contacted in 2010, 13-15 years after the injury. One patient had had a TFCC reattachment due to painful distal radioulnar joint instability and was excluded. Thirty-eight patients returned for a radiographic and clinical follow-up that recorded strength, distal radioulnar joint laxity, range of motion, pain scale score, and subjective and objective outcome scores.
After 13-15 years, 17/38 patients were lax in the distal radioulnar joint. The mean grip strength was worse in the patients with a lax distal radioulnar joint (83%, SD 15 of the contralateral side vs 103%, SD 33). The median Gartland and Werley score was 5 (good; range, 0-15) in the lax group compared to 1 (excellent; range, 0-9) in the non-lax group, and the median Disabilities of the Arm, Shoulder, and Hand scores were 14 (range, 0-59) and 5 (range, 0-70) respectively.
In this 13-15 year, prospective, longitudinal outcome study of the natural course of TFCC tears associated with distal radius fracture, only 1 patient had been operated on for painful instability since the injury. The subjective and objective results did not provide evidence that a TFCC injury would influence the long-term outcome. However, trends were found and, by speculation, the low number of patients in the series and the risk for a type II error could be the cause of absent statistically significance. Larger, preferably prospective, randomized studies are needed to find out whether a more aggressive treatment is beneficial.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic I.
评估在桡骨远端骨折移位患者中发现的未经治疗的创伤性三角纤维软骨复合体（TFCC）撕裂的前瞻性纵向病例系列的长期结果。
1995年至1997年间，51例（24例男性，27例女性；年龄20 - 57岁）桡骨远端骨折移位患者接受腕关节镜检查以确定相关损伤。43例患者存在TFCC完全或部分撕裂，未接受治疗。在受伤后13 - 15年的2010年联系了所有患者。1例患者因疼痛性桡尺远侧关节不稳定进行了TFCC重新附着手术，被排除在外。38例患者返回进行影像学和临床随访，记录力量、桡尺远侧关节松弛度、活动范围、疼痛量表评分以及主观和客观结果评分。
13 - 15年后，38例患者中有17例桡尺远侧关节松弛。桡尺远侧关节松弛的患者平均握力较差（对侧的83%，标准差15，而对侧为103%，标准差33）。松弛组的Gartland和Werley评分中位数为5（良好；范围0 - 15），而非松弛组为1（优秀；范围0 - 9），手臂、肩部和手部残疾评分中位数分别为14（范围0 - 59）和5（范围0 - 70）。
在这项对与桡骨远端骨折相关的TFCC撕裂自然病程进行的13 - 15年前瞻性纵向结果研究中，自受伤以来只有1例患者因疼痛性不稳定接受了手术。主观和客观结果未提供证据表明TFCC损伤会影响长期结果。然而，发现了一些趋势，据推测，该系列患者数量少以及II类错误风险可能是缺乏统计学意义的原因。需要进行更大规模、最好是前瞻性的随机研究，以确定更积极的治疗是否有益。
研究类型/证据水平：诊断性I级。
