Geller Joseph S, Taormina David P, Greene Janelle D, Dodds Seth D
University of Miami Miller School of Medicine, Department of Orthopedic Surgery and Rehabilitation, Bascom Palmer Institute, Department of Ortho, Miami, Florida.
Yale University School of Medicine, Department of Orthopedic Surgery and Rehabilitation, New Haven, Connecticut.
J Wrist Surg. 2021 Apr;10(2):144-149. doi: 10.1055/s-0040-1721410. Epub 2021 Jan 3.
An open volar surgical approach with suture anchor repair of the foveal ligament and temporary pinning of the distal radioulnar joint (DRUJ) is an effective way to treat DRUJ instability associated with chronic foveal tears of the triangular fibrocartilage complex (TFCC). We retrospectively reviewed nine patients with foveal ligament tears of the TFCC and DRUJ instability who underwent open repair of the TFCC using a volar surgical approach, combined with temporary pinning of the DRUJ for 8 weeks. Pain, instability, arc of motion, and functional outcomes scores were evaluated. Mean patient age was 40.5 years (range 16.3-56.2). Average time from injury to surgery was 8.4 months (range 2.9-23.3 months). Average final follow-up was 18.9 months from injury (range 12.0-29.3 months), 10.5 months from surgery (range 3.9-18.6 months), and 8.7 months from pin removal (range 1.7-17.2 months). At final follow-up, all patients demonstrated clinically stable DRUJ. Pain scores diminished significantly from pre to final postoperative visits, with averages of 6.8 (range 4.0-9.0) improving to a mean of 0.70 (range 0.0-2.0), respectively. Average postoperative forearm rotation was 71.1 degrees in supination and 76.1 degrees in pronation (average total arc of motion 147.2 degrees, range 90-160 degrees). Average postoperative wrist motion was 68.8 degrees in flexion and 70.6 degrees in extension (average total arc of motion 139.4 degrees, range 110-160 degrees). No patients developed crepitus, recurrent DRUJ instability, or required revision surgery (subsequent to pin removal). Volar suture anchor repair of the foveal ligament of the TFCC with DRUJ pinning led to reliable outcomes within this patient group including a stable DRUJ with improved functional outcomes regarding pain, stability, and range of motion in patients with foveal TFCC tears and associated DRUJ instability. These results compare favorably with dorsal repair of the foveal ligament. This is a Level IV, therapeutic study.
采用掌侧手术入路，用缝线锚钉修复中央凹韧带并临时固定桡尺远侧关节（DRUJ），是治疗与三角纤维软骨复合体（TFCC）中央凹慢性撕裂相关的DRUJ不稳的有效方法。我们回顾性分析了9例TFCC中央凹韧带撕裂并伴有DRUJ不稳的患者，这些患者采用掌侧手术入路对TFCC进行开放修复，并对DRUJ进行8周的临时固定。评估了患者的疼痛、不稳、活动弧度和功能结局评分。患者平均年龄为40.5岁（范围16.3 - 56.2岁）。受伤至手术的平均时间为8.4个月（范围2.9 - 23.3个月）。末次随访平均时间为受伤后18.9个月（范围12.0 - 29.3个月）、手术后10.5个月（范围3.9 - 18.6个月）、拔钉后8.7个月（范围1.7 - 17.2个月）。在末次随访时，所有患者的DRUJ在临床上均稳定。疼痛评分从术前到术后末次随访时显著降低，平均值分别从6.8（范围4.0 - 9.0）改善至0.70（范围0.0 - 2.0）。术后平均前臂旋前为71.1度，旋后为76.1度（平均总活动弧度147.2度，范围90 - 160度）。术后平均腕关节屈曲为68.8度，伸展为70.6度（平均总活动弧度139.4度，范围110 - 160度）。没有患者出现摩擦音、DRUJ复发性不稳或需要翻修手术（拔钉后）。TFCC中央凹韧带的掌侧缝线锚钉修复联合DRUJ固定在该患者组中取得了可靠的结果，包括DRUJ稳定，在TFCC中央凹撕裂并伴有DRUJ不稳的患者中，疼痛、稳定性和活动范围等功能结局得到改善。这些结果优于中央凹韧带的背侧修复。这是一项IV级治疗性研究。
