Osterman A L
Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104.
Arthroscopy. 1990;6(2):120-4. doi: 10.1016/0749-8063(90)90012-3.
This prospective study, begun in 1984, involves 52 consecutive patients treated arthroscopically for triangular fibrocartilage complex (TFCC) tears. Wrist arthrography showed the tear on the initial radiocarpal injection in 86%, and only on the post-stress films in 14%. Triple-phase bone scan was positive in only 66%. Diagnostic arthroscopy showed linear defects in 34%, a central perforation in 46%, and ulnar or peripheral perforations in 20%. However, 11 patients proved to have no visible TFCC tear (9% false-positive arthrography rate, or 9% false-negative rate for arthroscopy). Of the 41 patients followed for 13-42 months, 88% considered the procedure worthwhile, and 73% had complete relief of pain. The authors conclude that arthroscopic debridement of TFCC tears (often with removal of 2-3 mm of ulnar head) may be of benefit in reducing symptoms without increasing clinical ulnar instability. Wrist arthrography is useful in diagnosing perforations but not useful in evaluating the type, size, or significance of the tear.
这项前瞻性研究始于1984年，纳入了52例连续接受关节镜治疗三角纤维软骨复合体（TFCC）撕裂的患者。腕关节造影显示，86%的患者在初次桡腕关节注射时即显示撕裂，14%的患者仅在应力位片上显示撕裂。三相骨扫描仅66%呈阳性。诊断性关节镜检查显示，34%为线性缺损，46%为中央穿孔，20%为尺侧或周边穿孔。然而，11例患者经证实并无可见的TFCC撕裂（关节造影假阳性率为9%，或关节镜检查假阴性率为9%）。在41例随访13至42个月的患者中，88%认为该手术值得，73%的患者疼痛完全缓解。作者得出结论，关节镜下TFCC撕裂清创术（通常切除2至3毫米尺骨头）可能有助于减轻症状，而不会增加临床尺侧不稳定。腕关节造影有助于诊断穿孔，但对评估撕裂的类型、大小或意义并无帮助。
