关节镜下缝合锚钉与骨-隧道缝合技术治疗三角纤维软骨复合体窝状部撕裂的系统评价。
Effectiveness of suture anchor and transosseous suture technique in arthroscopic foveal repair of the triangular fibrocartilage complex: a systematic review.
机构信息
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
出版信息
J Orthop Surg Res. 2024 Jan 16;19(1):72. doi: 10.1186/s13018-024-04530-4.
BACKGROUND
Currently, there were two major surgical methods for arthroscopic triangular fibrocartilage complex (TFCC) foveal repair: suture anchor (SA) and transosseous suture (TOS). The purpose of this systematic review is to examine the relevant outcome improvement and safety of SA and TOS technique.
METHODS
Literature review of electronic databases for studies investigating the effects of SA and TOS in patients undergoing arthroscopic TFCC foveal repair was performed. We compared the pre-operative and postoperative functional outcomes, clinical outcomes [pain, range of motion (ROM) and grip strength], and complications of two methods. Minimal clinically important difference (MCID) was used to determine clinically meaningful improvement.
RESULTS
There were 1263 distinct studies identified, with 26 (904 patients) meeting the inclusion criteria. The mean age of participants ranged from 21.4 to 41 years, and the mean follow-up time ranged from 6 to 106 months. Both SA and TOS groups reported significant improvement in the modified mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, quick DASH score, patient-reported wrist evaluation (PRWE) score, and the visual analog scale (VAS) score. According to MCID, all the studies from both groups reporting DASH, quick DASH, PRWE and VAS score achieved clinically meaningful improvement. (MCID: 10 for DASH, 14 for quick DASH, 14 for PRWE and 1.6-18 for VAS). The ROM changes in both groups varied from improvement to deterioration. Grip strength improved in both SA and TOS group. Most complications were self-limited. The reoperation rates in SA and TOS ranged from 0 to 20% and 0 to 27.3%, respectively.
CONCLUSIONS
Both SA and TOS technique for arthroscopic TFCC foveal repair could achieve improvement in postoperative functional outcomes, pain, and grip strength with low reoperation rate. However, the ROM improvement was still inconclusive.
LEVEL OF EVIDENCE IV
Systematic review of level III and IV studies.
背景
目前，关节镜下三角纤维软骨复合体（TFCC）窝状修复有两种主要的手术方法：缝合锚钉（SA）和经骨缝合（TOS）。本系统评价的目的是研究 SA 和 TOS 技术在关节镜下 TFCC 窝状修复患者中的相关疗效改善和安全性。
方法
对电子数据库中关于 SA 和 TOS 治疗关节镜下 TFCC 窝状修复患者的研究进行文献回顾。我们比较了两种方法的术前和术后功能结果、临床结果[疼痛、活动范围（ROM）和握力]和并发症。使用最小临床重要差异（MCID）来确定有临床意义的改善。
结果
共确定了 1263 项不同的研究，其中 26 项（904 例患者）符合纳入标准。参与者的平均年龄为 21.4 至 41 岁，平均随访时间为 6 至 106 个月。SA 和 TOS 组的改良 Mayo 腕关节评分、臂肩手功能障碍（DASH）评分、快速 DASH 评分、患者报告的腕关节评估（PRWE）评分和视觉模拟评分（VAS）评分均有显著改善。根据 MCID，两组报告的 DASH、快速 DASH、PRWE 和 VAS 评分均达到了有临床意义的改善（MCID：DASH 为 10，快速 DASH 为 14，PRWE 为 14，VAS 为 1.6-18）。两组的 ROM 变化从改善到恶化不等。SA 和 TOS 组的握力均有改善。大多数并发症是自限性的。SA 和 TOS 组的再手术率分别为 0 至 20%和 0 至 27.3%。
结论
关节镜下 TFCC 窝状修复中，SA 和 TOS 技术均能改善术后功能结果、疼痛和握力，且再手术率较低。然而，ROM 的改善仍不确定。
证据等级 IV：对 III 级和 IV 级研究的系统评价。
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