Woo Sung Jong, Jegal Midum, Park Min Jong
Department of Orthopaedic Surgery, Prime Hospital, Busan, Korea.
Department of Orthopaedic Surgery, MS Jaegeon Hospital, Daegu, Korea.
Indian J Orthop. 2016 May-Jun;50(3):263-8. doi: 10.4103/0019-5413.181790.
Disruption of the triangular fibrocartilage complex (TFCC) foveal insertion can lead to distal radioulnar joint (DRUJ) instability accompanied by ulnar-sided pain, weakness, snapping, and limited forearm rotation. We investigated the clinical outcomes of patients with TFCC foveal tears treated with arthroscopic-assisted repair.
Twelve patients underwent foveal repair of avulsed TFCC with the assistance of arthroscopy between 2011 and 2013. These patients were followed up for an average of 19 months (range 14-25 months). The avulsed TFCC were reattached to the fovea using a transosseous pull-out suture or a knotless suture anchor. At the final followup, the range of motion, grip strength and DRUJ stability were measured as objective outcomes. Subjective outcomes were assessed using the Visual Analog Scale (VAS) for pain, patient rated wrist evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score) and return to work.
Based on the DRUJ stress test, 5 patients had normal stability and 7 patients showed mild laxity as compared with the contralateral side. Postoperatively, the mean range of pronation supination increased from 141° to 166°, and the mean VAS score for pain decreased from 5.3 to 1.7 significantly. The PRWE and DASH questionnaires also showed significant functional improvement. All patients were able to return to their jobs. However, two patients complained of persistent pain.
Arthroscopically assisted repair of TFCC foveal injury can provide significant pain relief, functional improvement and restoration of DRUJ stability.
三角纤维软骨复合体（TFCC）中央凹附着处断裂可导致下尺桡关节（DRUJ）不稳定，并伴有尺侧疼痛、无力、弹响及前臂旋转受限。我们研究了关节镜辅助修复治疗TFCC中央凹撕裂患者的临床疗效。
2011年至2013年期间，12例患者在关节镜辅助下接受了TFCC撕脱中央凹修复术。这些患者平均随访19个月（范围14 - 25个月）。使用经骨拉出缝线或无结缝线锚钉将撕脱的TFCC重新附着于中央凹。在末次随访时，测量活动范围、握力和DRUJ稳定性作为客观疗效指标。使用视觉模拟评分法（VAS）评估疼痛、患者腕关节评估（PRWE）、上肢、肩部和手部功能障碍问卷（DASH评分）以及恢复工作情况等主观疗效指标。
根据DRUJ应力试验，与对侧相比，5例患者稳定性正常，7例患者表现为轻度松弛。术后，旋前旋后平均活动范围从141°增加至166°，疼痛平均VAS评分从5.3显著降至1.7。PRWE和DASH问卷也显示功能有显著改善。所有患者均能够恢复工作。然而，2例患者仍主诉持续疼痛。
关节镜辅助修复TFCC中央凹损伤可显著缓解疼痛、改善功能并恢复DRUJ稳定性。
