Shim Jung-In, Im Jin-Hyung, Lee Joo-Yup, Kang Han-Vit, Cho Sung-Hyun
Department of Orthpaedic Surgery, St. Vincent's Hospital, Catholic University of Korea, Gyeonggi-Do, Korea.
Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Gyeongsangnam-Do, Korea.
J Wrist Surg. 2019 Feb;8(1):30-36. doi: 10.1055/s-0038-1668153. Epub 2018 Aug 17.
The relationship between triangular fibrocartilage complex (TFCC) tear and ulnar impaction syndrome has not been fully understood. We hypothesized that a TFCC tear could change the ulnar variance, which may be the cause of ulnar impaction syndrome. A total of 72 patients who underwent TFCC foveal repair between January 2011 and June 2016 were included in this retrospective study. Among them, 44 patients diagnosed with TFCC foveal tear with distal radioulnar joint instability and no ulnar impaction syndrome underwent TFCC foveal repair only (group A) and 28 patients diagnosed with TFCC foveal tear with ulnar impaction syndrome underwent TFCC foveal repair and ulnar shortening osteotomy simultaneously (group B). We measured their ulnar variances in preoperative, postoperative, and last follow-up plain radiography. We also compared them with the ulnar variance of the contralateral (uninjured) wrist. Postoperative clinical outcomes, such as range of motions of the wrist, the visual analog scale (VAS) for pain, grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, were assessed. Ulnar variance increased after TFCC tears compared with that on the uninjured side in both groups (group A: 0.98 vs. 0.52 mm, = 0.013; group B: 2.71 vs. 2.13 mm, = 0.001). Once the TFCC was repaired, ulnar variance decreased (group A: 0.98 to 0.01 mm, < 0.01; group B: 2.71 to 0.64 mm, < 0.01). However, it was increased on the last follow-up radiograph (group A: 0.01 to 0.81 mm, < 0.01; group B: 0.64 to 1.05 mm, = 0.004). There were no significant improvement of range of motion, except for pronation-supination motion ( = 0.04). Mean grip strength increased from 56.8 to 70.8% of the contralateral unaffected hand at the last assessment ( = 0.01). Mean VAS for pain decreased from 7.4 ± 2.5 preoperatively to 2.7 ± 2 postoperatively ( = 0.001). The QuickDASH score significantly improved from 45 to 9 ( = 0.001). Ulnar variance may be changed after a TFCC tear. In our study, it decreased after TFCC foveal repair. However, as time went on, the ulnar variance increased again, which could be one of the causes of ulnar impaction syndrome and ulnar-sided wrist pain. This is a therapeutic Level IV study.
三角纤维软骨复合体（TFCC）撕裂与尺骨撞击综合征之间的关系尚未完全明确。我们推测TFCC撕裂可能会改变尺骨变异，这可能是尺骨撞击综合征的病因。 本回顾性研究纳入了2011年1月至2016年6月期间接受TFCC中央凹修复的72例患者。其中，44例诊断为TFCC中央凹撕裂伴下尺桡关节不稳且无尺骨撞击综合征的患者仅接受了TFCC中央凹修复（A组），28例诊断为TFCC中央凹撕裂伴尺骨撞击综合征的患者同时接受了TFCC中央凹修复和尺骨短缩截骨术（B组）。我们在术前、术后及末次随访的X线平片上测量了他们的尺骨变异。我们还将其与对侧（未受伤）腕关节的尺骨变异进行了比较。评估了术后的临床疗效，如腕关节活动度、疼痛视觉模拟评分（VAS）、握力以及上肢、肩部和手部功能障碍快速评估量表（QuickDASH）评分。 与未受伤侧相比，两组患者TFCC撕裂后尺骨变异均增加（A组：0.98 vs. 0.52mm，P = 0.013；B组：2.71 vs. 2.13mm，P = 0.001）。TFCC修复后，尺骨变异减小（A组：0.98至0.01mm，P < 0.01；B组：2.71至0.64mm，P < 0.01）。然而，在末次随访X线片上尺骨变异再次增加（A组：0.01至0.81mm，P < 0.01；B组：0.64至1.05mm，P = 0.004）。除旋前 - 旋后活动度外，其他活动度均无显著改善（P = 0.04）。末次评估时平均握力从对侧未受影响手均值的56.8%增加至70.8%（P = 0.01）。疼痛平均VAS评分从术前的7.4±2.5降至术后的2.7±2（P = 0.001）。QuickDASH评分从45显著改善至9（P = 0.001）。 TFCC撕裂后尺骨变异可能会发生改变。在我们的研究中，TFCC中央凹修复后尺骨变异减小。然而，随着时间推移，尺骨变异再次增加，这可能是尺骨撞击综合征及尺侧腕部疼痛的原因之一。 这是一项治疗性IV级研究。
