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一种用于中央凹三角纤维软骨复合体损伤的改良关节镜下尺管技术。

A modified arthroscopic ulnar tunnel technique for foveal triangular fibrocartilage complex injury.

作者信息

Gvozdenovic Robert, Hessler Simonsen Sabine

机构信息

Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hellerup, Denmark.

Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

出版信息

J Plast Surg Hand Surg. 2023 Feb-Dec;57(1-6):308-314. doi: 10.1080/2000656X.2022.2070179. Epub 2022 May 9.

Abstract

Arthroscopically assisted techniques for the treatment of foveal triangular fibrocartilage complex (TFCC) injuries offer a less invasive option. Reports of the ulnar tunnel technique on a larger patient population are needed. This prospective cohort study of 44 patients aimed to evaluate the clinical and patient-reported outcome after arthroscopic foveal re-attachment using a novel, modified ulnar tunnel technique. Furthermore, preoperative magnetic resonance imaging findings were compared with the findings from the arthroscopic evaluation. History of ulnar sided wrist pain, positive fovea-sign at the clinical examination and positive hook test at the surgery were the main inclusion criteria for the study. Pain, grip strength, wrist motion and patient-reported outcomes were assessed pre-and postoperatively. The follow-up of this study was 31 months (range 18-48). No complications occurred during the surgery. All outcomes improved besides the range of motion, which remained unchanged. Pain on a visual analogue scale was 63 before, and 14 after the surgery ( = .0004). Pre- and postoperative values of Disability of Arm, Shoulder and Hand Questionnaire were 41/6, respectively ( = .007). Grip strength, measured in Kilogram-force were 29 and 36, pre-and postoperatively ( = .0004). Conspicuously, all patients achieved stability. Six patients needed re-operation, three for renewed injury. Thirty-nine of 44 patients scored excellent or good on the satisfaction score. We found the devised method to be with fewer complications and with favourable results compared with other techniques for the treatment of TFCC injuries. Level of evidence: III.

摘要

关节镜辅助技术治疗中央凹三角纤维软骨复合体(TFCC)损伤提供了一种侵入性较小的选择。需要有更多患者群体的尺骨隧道技术报告。这项对44例患者的前瞻性队列研究旨在评估使用一种新颖的改良尺骨隧道技术进行关节镜下中央凹重新附着术后的临床和患者报告结局。此外,还将术前磁共振成像结果与关节镜评估结果进行了比较。尺侧腕部疼痛病史、临床检查时中央凹征阳性以及手术时钩试验阳性是该研究的主要纳入标准。术前和术后评估疼痛、握力、腕关节活动度以及患者报告结局。本研究的随访时间为31个月(范围18 - 48个月)。手术期间未发生并发症。除了活动度保持不变外,所有结局均有所改善。视觉模拟量表上的疼痛术前为63,术后为14(P = 0.0004)。手臂、肩部和手部功能障碍问卷的术前和术后值分别为41/6(P = 0.007)。以千克力为单位测量的握力术前为29,术后为36(P = 0.0004)。值得注意的是,所有患者均实现了稳定。6例患者需要再次手术,3例是因为再次受伤。44例患者中有39例在满意度评分中获得优秀或良好。我们发现与其他治疗TFCC损伤的技术相比,所设计的方法并发症更少且效果良好。证据级别:III。

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