Rodríguez-Merchán E Carlos, Shojaie Babak, Kachooei Amir R
Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain.
Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain.
Arch Bone Jt Surg. 2022 Jan;10(1):3-16. doi: 10.22038/ABJS.2021.57194.2833.
Distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) tears are more usual than estimated and are frequently overlooked. Diagnosis is often clinical, which can be confirmed using computed tomography (CT) scan and magnetic resonance imaging (MRI). In doubtful cases, bilateral computed tomography in neutral forearm rotation, supination, and pronation should also be performed. Wrist arthroscopy can be diagnostic and therapeutic for ulnar-sided wrist pain. Two systematic reviews showed equivalent outcomes between open and arthroscopic repair of the TFCC. There is scant proof to advise one technique over the other in clinical practice. TFCC repair and reconstruction are contraindicated when there is a bony deformation of the radius or ulna or osteoarthritis of the DRUJ. With the advancement of implant arthroplasty, salvage procedures are less desirable. Constrained distal radioulnar arthroplasty is stable, and the longevity is encouraging.
下尺桡关节（DRUJ）不稳定和三角纤维软骨复合体（TFCC）撕裂比预估的更为常见，且常常被忽视。诊断通常依靠临床判断，可通过计算机断层扫描（CT）和磁共振成像（MRI）来确诊。在可疑病例中，还应进行双侧前臂中立位旋转、旋后和旋前位的计算机断层扫描。腕关节镜检查对尺侧腕部疼痛具有诊断和治疗作用。两项系统评价显示，TFCC开放修复和关节镜修复的效果相当。在临床实践中，几乎没有证据表明一种技术优于另一种技术。当存在桡骨或尺骨骨质变形或DRUJ骨关节炎时，禁忌进行TFCC修复和重建。随着植入物关节成形术的发展，挽救手术不太可取。限制性下尺桡关节置换术稳定，且使用寿命令人满意。
