Auzias P, Camus E J, Moungondo F, Van Overstraeten L
Service d'orthopédie, CHRU de Lille, hôpital Roger Salengro, rue du Professeur Emile-Laine, 59037 Lille cedex, France.
Polyclinique du Val de Sambre, 162, route de Mons, 59600 Maubeuge, France.
Hand Surg Rehabil. 2020 May;39(3):193-200. doi: 10.1016/j.hansur.2020.01.001. Epub 2020 Feb 4.
The main objective of this study was to evaluate the long-term clinical and radiological outcomes of arthroscopic-assisted foveal repair of proximal triangular fibrocartilage complex (TFCC) tears with an anchor. The secondary objective was to look for ligament damage associated with TFCC tears. Twenty-four patients who underwent foveal repair of the TFCC were evaluated retrospectively: 16 stage 2 and 8 stage 3 in the Atzei-EWAS classification. The TFCC was repaired with an anchor using an expanded 6U approach. Systematic testing of intrinsic and extrinsic ligaments was performed. The assessment criteria were pain on a visual analog scale (VAS), wrist joint range of motion, grip strength and pronation-supination strength, and the QuickDASH and PRWE outcome scores. X-rays were also taken to assess anchor position and to look for distal radioulnar (DRU) joint damage. The average follow-up was 44 months. After the surgical repair, pain was reduced (7.36±1.3 preoperatively vs. 0.69±1.3 postoperatively; P<0.001), the QuickDASH score improved (52.1±16 vs. 21.7±7; P<0.001), the PRWE score improved (83.7±35 vs. 9.3±12; P<0.001) as did strength (35 vs. 43kg; P<0.001). The DRU joint stability was also significantly improved. The time away from work was 2.6 months. During the arthroscopy exploration, 25% of patients had an ulnotriquetral ligament lesion and 8% had an ulnolunar ligament lesion in combination with their TFCC tear. Fifteen anchors were positioned in the anatomical fovea (62%). No DRU joint damage was noted. Six patients had neurapraxia of the dorsal branch of the ulnar nerve, although it recovered spontaneously. One patient still had hypoesthesia of the ulnar side of the fifth finger at 48 months. Arthroscopic-assisted foveal repair of the TFCC yields good results in terms of pain, strength and DRU joint stability. In one-quarter of cases, TFCC foveal tears are associated with lesions of the ulnotriquetral ligament. There is no long-term degeneration of the DRU joint.
本研究的主要目的是评估关节镜辅助下使用锚钉修复近端三角纤维软骨复合体（TFCC）中央凹撕裂的长期临床和影像学结果。次要目的是寻找与TFCC撕裂相关的韧带损伤。对24例行TFCC中央凹修复术的患者进行回顾性评估：根据阿策伊 - EWAS分类，其中16例为2期，8例为3期。采用扩展6U入路使用锚钉修复TFCC。对内在和外在韧带进行系统检查。评估标准包括视觉模拟评分法（VAS）疼痛评分、腕关节活动范围、握力和旋前 - 旋后力量，以及QuickDASH和PRWE结局评分。还进行X线检查以评估锚钉位置并寻找下尺桡（DRU）关节损伤。平均随访44个月。手术修复后，疼痛减轻（术前7.36±1.3 vs.术后0.69±1.3；P<0.001），QuickDASH评分改善（52.1±16 vs. 21.7±7；P<0.001），PRWE评分改善（83.7±35 vs. 9.3±12；P<0.001），力量也有所改善（35 vs. 43kg；P<0.001）。DRU关节稳定性也显著改善。误工时间为2.6个月。在关节镜探查期间，25%的患者伴有尺三角韧带损伤，8%的患者伴有尺月韧带损伤合并TFCC撕裂。15枚锚钉位于解剖学中央凹（62%）。未发现DRU关节损伤。6例患者出现尺神经背支神经失用，但均自发恢复。1例患者在48个月时仍有小指尺侧感觉减退。关节镜辅助下TFCC中央凹修复术在疼痛、力量和DRU关节稳定性方面取得了良好效果。在四分之一的病例中，TFCC中央凹撕裂与尺三角韧带损伤相关。DRU关节无长期退变。
