Tünnerhoff H-G
Praxis und Belegabteilung für Hand- und Fußchirurgie, Krankenhaus Marbach, Panoramastraße 9/1, 71672, Marbach am Neckar, Deutschland.
Orthopade. 2018 Aug;47(8):655-662. doi: 10.1007/s00132-018-3595-7.
Traumatic ruptures of the triangular fibrocartilaginous complex (TFCC) may cause ulnar-sided wrist pain. These ruptures frequently lead to instability of the distal radioulnar joint (DRUJ) because the ulnoradial ligaments, which are interwoven with the TFCC, are avulsed from the fovea of the ulnar head or-very rarely-from the radius. Conservative treatment may be sufficient, and some instability may be tolerated over time. In the case of persistent pain, operative repair by reattachment of the TFCC and, thereby, the ligaments to the previously debrided bone in the fovea is effective in reestablishing a stable, pain free DRUJ. Several arthroscopic and open repair techniques have been described in the last years. Contraindications such as the ulna-plus-situation or instability due to even minor degrees of malunion after fractures of the forearm bones must be kept in mind.An overview is given of the pathological anatomy, diagnosis, indications and suturing techniques.
三角纤维软骨复合体(TFCC)的创伤性撕裂可能导致尺侧腕部疼痛。这些撕裂常常导致下尺桡关节(DRUJ)不稳定,因为与TFCC交织的尺桡侧韧带会从尺骨头的凹部撕脱,或者极罕见地从桡骨撕脱。保守治疗可能就足够了,随着时间推移,一些不稳定情况可能会被耐受。对于持续疼痛的情况,通过将TFCC以及韧带重新附着于凹部先前清创的骨上进行手术修复,对于重建稳定、无痛的下尺桡关节是有效的。在过去几年中,已经描述了几种关节镜和开放修复技术。必须牢记一些禁忌症,如尺骨阳性情况或前臂骨骨折后即使轻度畸形愈合导致的不稳定。本文对病理解剖、诊断、适应症和缝合技术进行了概述。