Tse Wing-Lim, Lau Sun-Wing, Wong Wing Yee, Cheng Hi-Shan, Chow Ching-Shan, Ho Pak-Cheong, Hung Leung-Kim
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Department of Orthopaedics and Traumatology, United Christian's Hospital, Hong Kong, China.
Injury. 2013 Mar;44(3):386-90. doi: 10.1016/j.injury.2013.01.009. Epub 2013 Jan 18.
To report the 10-years' experience of a novel arthroscopic assisted anatomical TFCC reconstruction in treatment of chronic DRUJ instability resulting from irreparable TFCC injuries.
15 patients (7 males, 8 females) with mean age of 37 (17-49) suffering from irreparable TFCC injuries received arthroscopic assisted reconstruction using palmaris longus graft. Three skin incisions were made with creation of one radial and one ulna tunnel for passage of graft following the path of dorsal and palmar radio-ulnar ligaments under fluoroscopic and arthroscopic guidance. The joint capsule was kept intact. Early mid-range forearm rotation was started since 4th week postoperatively.
The mean follow-up was 85.53 months (32-138). Mayo wrist score improved from 62.5 to 88 (p<0.05). Comparing contralateral side, total prono-supination range increased from 76.6% to 92.1% and grip strength increased from 56.1% to 76.9%. Twelve patients resumed previous jobs. No evidence of DRUJ arthritis was noticed. Complications included 2 late graft ruptures and one unexplained dystonia.
Our arthroscopic assisted approach on TFCC reconstruction is safe, produces comparable results as the standard technique and may achieve better range of motion with less soft tissue dissection and earlier mobilization.
报告一种新型关节镜辅助下解剖学三角纤维软骨复合体（TFCC）重建术治疗因不可修复的TFCC损伤导致的慢性下尺桡关节（DRUJ）不稳的10年经验。
15例（7例男性，8例女性）平均年龄37岁（17 - 49岁）的不可修复TFCC损伤患者接受了关节镜辅助下掌长肌腱移植重建术。在透视和关节镜引导下，做三个皮肤切口，沿背侧和掌侧桡尺韧带路径创建一个桡侧和一个尺侧隧道用于移植肌腱通过。关节囊保持完整。术后第4周开始早期进行前臂中度旋转活动。
平均随访85.53个月（32 - 138个月）。Mayo腕关节评分从62.5提高到88（p<0.05）。与对侧相比，总的旋前 - 旋后范围从76.6%增加到92.1%，握力从56.1%增加到76.9%。12例患者恢复了之前的工作。未发现DRUJ关节炎迹象。并发症包括2例晚期移植肌腱断裂和1例不明原因的肌张力障碍。
我们的关节镜辅助下TFCC重建方法是安全的，产生的结果与标准技术相当，并且可能通过更少的软组织分离和更早的活动实现更好的活动范围。
