Massachusetts General Hospital, Boston, USA.
Amsterdam UMC, location VUmc, The Netherlands.
Hand (N Y). 2022 May;17(3):483-490. doi: 10.1177/1558944720937369. Epub 2020 Jul 19.
The clinical picture of ulnar-sided wrist pain is oftentimes confusing because various pathologies may be coexistent. In this study, we aimed: (1) to compare the prevalence of potential causes of ulnar-sided wrist pain on magnetic resonance imaging (MRI) in patients who underwent triangular fibrocartilage complex (TFCC) repair and control subjects: and (2) to evaluate whether inferior clinical results were associated with specific patient characteristics or other potential causes of ulnar-sided wrist pain. We included 67 patients who underwent a TFCC repair and 67 control subjects. The MRI scans were examined for sources of ulnar-sided wrist pain. After TFCC repair, 42 patients (63%) completed surveys, including Quick Disabilities of the Arm, Shoulder and Hand and pain scores. Bivariate analysis was performed to compare our groups and to identify factors associated with our outcomes. We found significantly higher rates of distal radioulnar joint (DRUJ) arthritis ( = .033), extensor carpi ulnaris (ECU) pathology ( = .028), and ulnar styloid fractures ( = .028) in patients with TFCC repairs. With increasing age, increasing pathology in the pisotriquetral joint ( = .040), more ulnocarpal abutment ( = .0081), and more degenerative tears ( < .001) were seen in both groups. No demographic characteristics or MRI findings were significantly associated with our outcomes. We observed higher rates of DRUJ arthritis and ECU pathology in patients with TFCC tears undergoing repair compared with age- and sex-matched controls. This may be due to damage to the TFCC itself altering relationships of the DRUJ and the ECU subsheath, or it may reflect various pathologies that cause ulnar-sided wrist pain and drive patients toward surgery.
尺侧腕部疼痛的临床表现常常令人困惑,因为多种病变可能同时存在。在本研究中,我们旨在:(1)比较接受三角纤维软骨复合体(TFCC)修复的患者和对照组患者磁共振成像(MRI)上潜在尺侧腕部疼痛原因的患病率;(2)评估较差的临床结果是否与特定患者特征或其他潜在尺侧腕部疼痛原因相关。
我们纳入了 67 例接受 TFCC 修复的患者和 67 例对照组患者。对 MRI 扫描进行了检查,以确定尺侧腕部疼痛的来源。TFCC 修复后,42 例患者(63%)完成了包括 Quick Disabilities of the Arm, Shoulder and Hand 和疼痛评分在内的问卷调查。我们进行了单变量分析以比较我们的两组,并确定与我们的结果相关的因素。
我们发现接受 TFCC 修复的患者的远端桡尺关节(DRUJ)关节炎( =.033)、伸肌腕短肌(ECU)病变( =.028)和尺骨茎突骨折( =.028)的发生率明显更高。在两组患者中,随着年龄的增长,舟月三角关节( =.040)的病变增多,尺腕关节过度吻合( =.0081)和退行性撕裂增多( <.001)。没有任何人口统计学特征或 MRI 发现与我们的结果显著相关。
与年龄和性别匹配的对照组相比,接受 TFCC 撕裂修复的患者的 DRUJ 关节炎和 ECU 病变发生率更高。这可能是由于 TFCC 本身的损伤改变了 DRUJ 和 ECU 鞘的关系,也可能反映了导致尺侧腕部疼痛并促使患者接受手术的各种病变。