摘要
目的探讨关节镜下带线锚钉套圈缝合法修复三角纤维软骨复合体(TFCC)尺侧撕裂的临床疗效。方法采用回顾性病例系列研究分析2019年2月至2020年10月宁波市第六医院收治的46例TFCC尺侧撕裂患者的临床资料,其中男28例,女18例;年龄18~64岁[(35.9±10.3)岁]。均为单侧撕裂,其中左侧18例,右侧28例。均为Palmer IB型损伤。术中在尺骨茎突近端均置入锚钉1枚,采用关节镜下带线锚钉套圈缝合法修复TFCC尺侧撕裂。比较术前、术后3个月及末次随访时视觉模拟评分(VAS)、改良Mayo腕关节评分、上肢功能评定量表(DASH)评分、手部握力、腕关节屈伸及前臂旋转活动度。观察手术切口愈合及术后并发症发生情况。结果患者均获随访13~35个月[24.0(17.5,28.0)个月]。VAS、改良Mayo腕关节评分、DASH评分及手部握力分别由术前(4.2±0.9)分、(72.9±8.1)分、(27.9±4.7)分、(17.4±3.6)kg改善至术后3个月的(2.6±1.7)分、(82.1±6.1)分、(15.3±4.2)分、(20.3±3.5)kg和末次随访时的(0.7±0.3)分、(91.8±4.2)分、(12.3±3.8)分、(23.6±4.1)kg(P<0.05或0.01),且VAS、改良Mayo腕关节评分、DASH评分及手部握力末次随访时较术后3个月进一步改善(P均<0.05)。末次随访时,改良Mayo腕关评分优28例,良14例,可4例,优良率为91.3%(42/46)。腕关节屈伸及前臂旋转活动度术前、术后3个月及末次随访时差异无统计学意义(P均>0.05)。手术切口均Ⅰ期愈合。术后手背尺侧及环小指近节背侧皮肤感觉减退、麻木3例,锚钉置入处压痛2例。末次随访时,均未发生锚钉松动、脱出。结论关节镜下带线锚钉套圈缝合法能有效缓解腕关节尺侧疼痛、改善腕关节及上肢功能并提高手部握力,术后并发症少,是治疗TFCC尺侧撕裂的有效方法。
Objective To explore the clinical efficacy of arthroscopic repair of ulnar tear of triangular fibrocartilage complex(TFCC)by loop stitch using a suture anchor.Methods A retrospective case series study was used to analyze the clinical data of 46 patients with TFCC ulnar tear admitted to Ningbo Sixth Hospital from February 2019 to October 2020,including 28 males and 18 females;aged 18‑64 years[(35.9±10.3)years].All the patients had unilateral tears,including 18 on the left side and 28 on the right side,and all of them had Palmer type IB injuries.During the operation,one anchor was placed in the proximal end of the ulnar styloid process,and the ulnar side tear of the TFCC was repaired using arthroscopic anchor loop suture method.The visual analogue score(VAS),modified Mayo wrist score,disability of the arm,shoulder and hand(DASH)score,hand grip strength,wrist flexion and extension,and forearm rotation range of motion were compared before operation,at 3 months after operation,and at the last follow‑up.The healing of surgical incisions and postoperative complications were observed.Results All the patients were followed up for 13‑35 months[24.0(17.5,28.0)months].The VAS,modified Mayo wrist score,DASH score and hand grip strength were improved from preoperative(4.2±0.9)points,(72.9±8.1)points,(27.9±4.7)points and(17.4±3.6)kg to(2.6±1.7)points,(82.1±6.1)points,(15.3±4.2)points and(20.3±3.5)kg at postoperative 3 months,and to(0.7±0.3)points,(91.8±4.2)points,(12.3±3.8)minutes and(23.6±4.1)kg at the last follow‑up(P<0.05 or 0.01),which were further improved at the last follow‑up when compared to those at postoperative 3 months(all P<0.05).Based on the modified Mayo wrist score,the results were excellent in 28 patients,good in 14,and fair in 4 at the last follow‑up,with an excellent and good rate of 91.3%(42/46).No significant differences were found in the wrist flexion‑extension or forearm rotation range of motion before operation,at 3 months after operation,or at the last follow‑up(all P>0.05).
作者
祝斌
蔡晓明
李俊杰
陈益
张健
竺枫
王欣
Zhu Bin;Cai Xiaoming;Li Junjie;Chen Yi;Zhang Jian;Zhu Feng;Wang Xin(Department of Hand Surgery,Ningbo Sixth Hospital,Ningbo 315000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2023年第9期823-829,共7页
Chinese Journal of Trauma
关键词
腕关节
关节镜检查
韧带
关节
缝合锚
Carpal joints
Arthroscopy
Ligaments,articular
Suture anchors
