Weiss A P, Akelman E, Lambiase R
Department of Orthopaedics, Brown University, Rhode Island Hospital, Providence, USA.
J Bone Joint Surg Am. 1996 Mar;78(3):348-56. doi: 10.2106/00004623-199603000-00005.
Fifty consecutive patients who had a history and clinical findings consistent with internal derangement of the wrist were prospectively entered into a study to compare the findings of triple-injection arthrography with those of arthroscopy of the wrist with use of three portals. Twenty-six patients were men, and twenty-four were women. They had an average age of thirty-six years (range, eighteen to seventy years). The average duration of symptoms in the wrist was eight months (range, one to twenty-four months). The arthrograms of the wrist, which included cineradiographs, were all made and evaluated by the same radiologist. The arthroscopic evaluation of the wrists was performed by two hand surgeons who had previous knowledge of the arthrographic findings. The abnormal findings included in this study were limited to those that should be detectable with both arthrography and arthroscopy. These were full-thickness tears of the scapholunate ligament, the lunotriquetral ligament and the triangular fibrocartilage. The findings of arthrography were normal in eighteen wrists, demonstrated a single lesion in twenty-one, and demonstrated multiple lesions in eleven. Twelve wrists were noted to have a tear of the scapholunate ligament; fifteen, a tear of the lunotriquetral ligament; and eighteen, a tear of the triangular fibrocartilage. The arthroscopic findings were normal in six wrists, demonstrated a single lesion in twenty-five, and demonstrated multiple lesions in nineteen. Twenty-two wrists were noted to have a tear of the scapholunate ligament; fifteen, a tear of the lunotriquetral ligament; and thirty, a tear of the triangular fibrocartilage. When compared with arthroscopy of the wrist, the sensitivity, specificity, and accuracy of triple-injection cinearthrography in detecting tears of the scapholunate ligament, lunotriquetral ligament, and triangular fibrocartilage, as a group, were 56, 83,and 60 per cent. Although arthrography of the wrist is a well accepted diagnostic modality in the evaluation of pain in the wrist, this study suggests that normal arthrographic findings do not necessarily rule out the possibility of internal derangement of the wrist.
五十例有腕关节内紊乱病史且临床检查结果相符的患者被前瞻性纳入一项研究，以比较三联注射关节造影与通过三个入路进行腕关节镜检查的结果。二十六例为男性，二十四例为女性。他们的平均年龄为三十六岁（范围为十八岁至七十岁）。腕部症状的平均持续时间为八个月（范围为一至二十四个月）。包括动态放射照片的腕关节造影均由同一位放射科医生完成并评估。腕关节镜检查由两位事先知晓关节造影结果的手外科医生进行。本研究纳入的异常发现仅限于关节造影和关节镜检查均能检测到的情况。这些情况包括舟月韧带、月三角韧带和三角纤维软骨的全层撕裂。关节造影结果显示，十八例腕关节正常，二十一例有单个病变，十一例有多个病变。发现十二例腕关节有舟月韧带撕裂；十五例有月三角韧带撕裂；十八例有三角纤维软骨撕裂。关节镜检查结果显示，六例腕关节正常，二十五例有单个病变，十九例有多个病变。二十二例腕关节有舟月韧带撕裂；十五例有月三角韧带撕裂；三十例有三角纤维软骨撕裂。与腕关节镜检查相比，三联注射动态关节造影在检测舟月韧带、月三角韧带和三角纤维软骨撕裂方面，作为一个整体，其敏感性、特异性和准确性分别为56%、83%和60%。虽然腕关节造影在评估腕部疼痛方面是一种广泛接受的诊断方法，但本研究表明，关节造影结果正常并不一定排除腕关节内紊乱的可能性。
