Burrell College of Osteopathic Medicine, Las Cruces, NM, USA.
Hand and Microsurgery Center of El Paso, TX, USA.
Hand (N Y). 2022 Dec;17(1_suppl):75S-80S. doi: 10.1177/15589447211057300. Epub 2021 Dec 28.
Arthroscopic and open surgical procedures are commonly used to repair distal radioulnar joint (DRUJ) instability. Both may result in patient dissatisfaction and recurrence of DRUJ instability. An alternative treatment that yields improved outcomes is a limited open approach using a bone anchor to support the DRUJ.
A retrospective chart review of 58 patients (59 extremities) aged 18 to 60 years with type 1B Palmer rupture (3 months or more after injury) of the triangular fibrocartilage complex (TFCC) without distal radius fracture was conducted. Inclusion criteria are: 3 to 12 months after injury, clinical DRUJ instability, and minimum of 6 months of postoperative follow-up. Operative fixation with Stryker Sonic or Depuy Mitek anchor was done by the same surgeon using a limited open procedure. Preoperative and postoperative assessments included Disability of the Arm, Shoulder, and Hand; Brief Pain Inventory; Wong-Baker FACES Pain Rating Scale; Numeric Pain Scale; range of motion; and recurrence of instability. A multivariate analysis of variance model was fit to imputed data to assess the effect of both anchors.
Clinical and statistical differences were found in preoperative and postoperative assessments for either the Stryker Sonic or the Depuy Mitek anchor but not between anchor types. There was no recurrence after 3 years with either anchor.
Patients requiring TFCC repair using the Stryker Sonic or Depuy Mitek anchor experienced: (1) significant clinical and statistical improvement in postoperative assessments; (2) patient satisfaction; and (3) corrected DRUJ instability. Consequently, major determinants in deciding which bone anchor to use may be based on cost or surgeon's preference.
关节镜和开放式手术通常用于修复桡尺远侧关节（DRUJ）不稳定。这两种方法都可能导致患者不满意和 DRUJ 不稳定复发。一种替代治疗方法是使用骨锚固定以支撑 DRUJ 的有限开放式手术，可获得更好的结果。
对 58 例（59 侧）年龄在 18 至 60 岁的 1B 型 Palmer 三角纤维软骨复合体（TFCC）撕裂（受伤后 3 个月或更长时间）且无桡骨远端骨折的患者进行回顾性图表分析。纳入标准为：受伤后 3 至 12 个月，存在临床 DRUJ 不稳定，且术后随访至少 6 个月。同一外科医生采用有限开放式手术，使用 Stryker Sonic 或 Depuy Mitek 锚固定进行手术固定。术前和术后评估包括手臂、肩部和手部残疾；简明疼痛量表；Wong-Baker FACES 疼痛评分量表；数字疼痛量表；活动范围；以及不稳定的复发。使用多元方差分析模型对插补数据进行拟合，以评估两种锚的效果。
Stryker Sonic 或 Depuy Mitek 锚的术前和术后评估均存在临床和统计学差异，但锚的类型之间没有差异。两种锚均未出现 3 年后的复发。
使用 Stryker Sonic 或 Depuy Mitek 锚修复 TFCC 的患者：（1）术后评估的临床和统计学改善显著；（2）患者满意度高；（3）DRUJ 不稳定得到纠正。因此，决定使用哪种骨锚的主要决定因素可能基于成本或外科医生的偏好。
