Jang Eugene, Danoff Jonathan R, Rajfer Rebecca A, Rosenwasser Melvin P
Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York.
J Wrist Surg. 2014 Feb;3(1):30-6. doi: 10.1055/s-0033-1364090.
Background The etiologies and outcomes of cases of failed therapeutic wrist arthroscopy have not been well-described to date. Purpose The purposes of this study were to identify common preventable patterns of failure in wrist arthroscopy and to report outcomes of a series of revision arthroscopy cases. Patients and Methods Retrospective review of 237 wrist arthroscopies revealed 21 patients with a prior arthroscopy for the same symptoms, of which 16 were assessed by questionnaires and physical exam for this study. Results Six of sixteen patients (38%) had unrecognized dynamic ulnar impaction after débridement of triangular fibrocartilage complex (TFCC) tears, which resolved with arthroscopic wafer resection. Five (31%) had persistent distal radioulnar joint (DRUJ) instability after initial treatment of TFCC tears, requiring arthroscopic repair at revision. Four (25%) experienced diffuse dorsal wrist pain initially diagnosed as TFCC tears, but dynamic scapholunate ligament injuries were found and addressed with radiofrequency (RF) shrinkage at reoperation. Two (13%) required further resection of the radial styloid, after initial débridement was insufficient to correct radioscaphoid impingement. At a mean of 4.8 years after repeat arthroscopy (range, 1.5-13.4 years), this cohort had significant improvements in pain and satisfaction with outcomes after revision arthroscopy. Conclusions The most common indications for repeat wrist arthroscopy were ligamentous instability (of the DRUJ or scapholunate ligament) and osteoarthritis (from dynamic ulnar impaction or radioscaphoid impingement). Although revision wrist arthroscopy may yield acceptable outcomes, careful assessment of stability and cartilage wear at index procedure is crucial.
Level IV Therapeutic.
背景 目前对于治疗性腕关节镜手术失败病例的病因及结果尚未有充分描述。目的 本研究旨在确定腕关节镜手术中常见的可预防失败模式，并报告一系列翻修关节镜手术病例的结果。患者与方法 对237例腕关节镜手术进行回顾性分析，发现21例曾因相同症状接受过关节镜手术，其中16例纳入本研究，通过问卷调查和体格检查进行评估。结果 16例患者中有6例（38%）在三角纤维软骨复合体（TFCC）撕裂清创术后存在未被识别的动态尺骨撞击，经关节镜下切除骨块后症状缓解。5例（31%）在TFCC撕裂初始治疗后存在持续性下尺桡关节（DRUJ）不稳定，翻修时需行关节镜修复。4例（25%）最初表现为弥漫性腕背侧疼痛，最初诊断为TFCC撕裂，但术中发现并处理了动态舟月韧带损伤，再次手术时采用射频（RF）收缩治疗。2例（13%）在初次清创不足以纠正桡舟撞击后，需要进一步切除桡骨茎突。在再次关节镜手术后平均4.8年（范围1.5 - 13.4年），该队列患者在翻修关节镜手术后疼痛和对结果的满意度有显著改善。结论 再次腕关节镜手术最常见的指征是韧带不稳定（DRUJ或舟月韧带）和骨关节炎（由动态尺骨撞击或桡舟撞击引起）。虽然翻修腕关节镜手术可能产生可接受的结果，但在初次手术时仔细评估稳定性和软骨磨损至关重要。
IV级治疗性。
