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未治疗的三角纤维软骨复合体(TFCC)撕裂对桡骨远端骨折保守治疗临床疗效的影响。

Effect of untreated triangular fibrocartilage complex (TFCC) tears on the clinical outcome of conservatively treated distal radius fractures.

作者信息

Deniz Gokmen, Kose Ozkan, Yanik Serhat, Colakoglu Tugrul, Tugay Ali

机构信息

Batman Medical Park Hospital, Orthopaedics and Traumatology Clinic, Batman, Turkey.

出版信息

Eur J Orthop Surg Traumatol. 2014 Oct;24(7):1155-9. doi: 10.1007/s00590-013-1389-5. Epub 2013 Dec 7.

Abstract

OBJECTIVE

The purpose of this study was to investigate the effect of untreated triangular fibrocartilage complex (TFCC) tear on the clinical outcome of conservatively treated distal radius fractures.

MATERIALS AND METHODS

This prospective study comprised 47 consecutive patients who presented at our clinic between January 2009 and January 2010 with displaced radius distal fracture and were treated with closed reduction and casting. During the first 15 days of treatment, all patients underwent wrist MR imaging to detect traumatic TFCC tears. At the final follow-up, all patients were evaluated with Mayo wrist function score and wrist radiographs. Patients were divided into two groups according to presence of TFCC tear, and two groups were analyzed statistically.

RESULTS

The mean follow-up period was 38.9 ± 3.5 months (range 36-48). TFCC tear was detected in 24 cases, and remaining 23 cases had no TFCC tear. Both groups were statistically similar regarding age (p = 0.574), gender (p = 0.108), dominant side involvement (p = 0.339), fracture type (p = 0.709) and immobilization period (p = 0.514). According to Mayo wrist score, excellent results were obtained in 21 (44.7%) cases, good in 16 (34.0%) and satisfactory in 10 (21.3%). No significant difference was observed between groups in wrist function scores (p = 0.451). Radiographic measurements were similar between groups (radial length p = 0.835, volar til p = 0.464, radial inclination p = 0.795).

CONCLUSIONS

Traumatic TFCC tears which are frequently seen together with distal radius fractures do not affect the long-term functional results. Therefore, further diagnostic tests and treatment of TFCC tears in patients with stable distal radius fractures may be unnecessary. However, it should be borne in mind as a reason for continuing wrist pain and instability after distal radius fractures despite proper radiologic recovery.

摘要

目的

本研究旨在探讨未治疗的三角纤维软骨复合体(TFCC)撕裂对保守治疗的桡骨远端骨折临床疗效的影响。

材料与方法

本前瞻性研究纳入了2009年1月至2010年1月期间连续47例因桡骨远端移位骨折前来我院就诊并接受闭合复位及石膏固定治疗的患者。在治疗的前15天内,所有患者均接受腕部磁共振成像检查以检测创伤性TFCC撕裂。在末次随访时,所有患者均采用梅奥腕关节功能评分及腕部X线片进行评估。根据TFCC撕裂的存在情况将患者分为两组,并对两组进行统计学分析。

结果

平均随访时间为38.9±3.5个月(范围36 - 48个月)。24例患者检测到TFCC撕裂,其余23例患者未发生TFCC撕裂。两组在年龄(p = 0.574)、性别(p = 0.108)、优势侧受累情况(p = 0.339)、骨折类型(p = 0.709)及固定时间(p = 0.514)方面在统计学上相似。根据梅奥腕关节评分,21例(44.7%)患者结果为优,16例(34.0%)为良,10例(21.3%)为可。两组在腕关节功能评分方面未观察到显著差异(p = 0.451)。两组间影像学测量结果相似(桡骨长度p = 0.835,掌倾角p = 0.464,桡骨倾斜角p = 0.795)。

结论

常与桡骨远端骨折同时出现的创伤性TFCC撕裂并不影响长期功能结果。因此,对于稳定的桡骨远端骨折患者,可能无需进一步进行TFCC撕裂的诊断检查及治疗。然而,应将其视为桡骨远端骨折经适当影像学恢复后仍持续存在腕部疼痛及不稳定的原因。

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