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带非吸收缝线的黄斑三角纤维软骨复合体撕裂修复。

Foveal Triangular Fibrocartilage Complex Tear Repair With Nonabsorbent Suture Tape.

机构信息

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

出版信息

J Hand Surg Am. 2024 Jul;49(7):709.e1-709.e8. doi: 10.1016/j.jhsa.2022.09.009. Epub 2023 Feb 24.

Abstract

PURPOSE

Arthroscopic repair is performed for fovea injuries of the triangular fibrocartilage complex (TFCC) when instability of the distal radioulnar joint results in pain, decreased grip strength, and mechanical symptoms. During TFCC repair, reconstruction of its attachment to the fovea is important. Nonabsorbent suture tapes have gained attention for ligament repair in the trapeziometacarpal joint, scapholunate ligament, and thumb metacarpophalangeal ligament. However, there are no reports of TFCC repair using suture tapes. We evaluated the early postoperative results of this approach.

METHODS

Participants underwent arthroscopic suture tape repair of foveal TFCC tears and were observed for more than 1 year. All repairs were performed using suture tapes and an outside-in technique with a bone tunnel from the ulnar shaft to the fovea. The postoperative complications, postoperative wrist range of motion, grip strength, and the Modified Mayo Score were evaluated.

RESULTS

Arthroscopic repair with a suture tape was performed for 20 hands using the outside-in technique. The ranges of motion for the operated and nonoperated hands were comparable 1 year after surgery (pronation, 84° ± 4°; supination, 83° ± 4°). The mean grip strength improved from 65% ± 13% before surgery to 89% ± 9% after a year. The mean Modified Mayo Score improved from 58 ± 11 before surgery to 91 ± 8 after a year. Postoperative complications included abnormal sensation of the dorsal ulnar side in 2 hands.

CONCLUSIONS

After using a suture tape to attach the TFCC to the fovea, satisfactory function was achieved in the early postoperative period with grip strength restoration. For the repair of foveal TFCC tears, attachment to the ulnar fovea is important, and repair by a suture tape may be useful.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

摘要

目的

当桡尺远侧关节不稳导致疼痛、握力下降和出现机械症状时,采用关节镜下修复三角纤维软骨复合体(TFCC)的月骨窝损伤。在 TFCC 修复过程中,重建其与月骨窝的附着非常重要。不可吸收缝线带在掌指关节、舟月韧带和拇指掌指关节韧带的韧带修复中受到关注。然而,尚无 TFCC 修复使用缝线带的报道。我们评估了这种方法的早期术后结果。

方法

参与者接受关节镜下缝线带修复月骨窝 TFCC 撕裂,并观察超过 1 年。所有修复均采用缝线带和从尺骨茎突到月骨窝的外侧入路骨隧道技术进行。评估术后并发症、术后腕关节活动度、握力和改良 Mayo 评分。

结果

采用外侧入路技术,用缝线带进行了 20 只手的关节镜修复。手术后 1 年,手术手和非手术手的活动范围相当(旋前,84°±4°;旋后,83°±4°)。握力从术前的 65%±13%平均提高到术后 1 年的 89%±9%。改良 Mayo 评分从术前的 58±11 平均提高到术后 1 年的 91±8。术后并发症包括 2 只手出现背侧尺侧异常感觉。

结论

使用缝线带将 TFCC 固定到月骨窝后,在早期术后阶段,握力恢复可获得满意的功能。对于月骨窝 TFCC 撕裂的修复,与尺骨窝的附着非常重要,缝线带修复可能有用。

研究类型/证据水平:治疗性 IV 级。

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