关节镜下三种技术修复腕三角纤维软骨复合体比较△（开放获取）

(Open Access) Comparison of three arthroscopic techniques for repair of wrist triangular fibrocartilage complex tear

摘要:

[目的] 比较腕关节镜下关节囊缝合（capsule suture, CS），穿单骨道（single bone tunnel, SBT） 及Y 形双骨道（dou-ble bone tunnels, DBT） 三种技术修复三角纤维软骨复合体（triangular fibrocartilage complex, TFCC） Palmer IB 型损伤的临床疗效。[方法] 回顾性分析2014 年6 月—2023 年9 月本院采用关节镜治疗的49 例TFCC IB 型损伤患者的临床资料。依据术前医患沟通结果，将患者分为三组， 14 例采用CS，19 例采用SBT，16 例采用DBT。比较三组围手术期、随访及影像结果。[结果] 三组患者均顺利完成手术。CS 组手术时间[(106.5±15.4) min vs (170.6±15.7) min vs (163.1±19.2) min, P＜0.001] 和术中失血量[(14.0±3.5) ml vs (50.1±15.8) ml vs (46.7±13.4) ml, P＜0.001] 显著优于SBT 组及DBT 组，但CS 组后外固定时间显著长于SBT 组及DBT 组[(50.1±6.1) d vs (33.6±7.2) d vs (31.9±4.8) d, P＜0.001] 。随访（14.0±5.6） 个月，CS 组完全负重活动时间显著晚于SBT 组和DBT 组[(55.8±3.1) d vs (45.1±3.3) d vs (37.5±5.5) d, P＜0.001]。与术前相比，末次随访时三组患者VAS 评分、Mayo 评分、伸-屈ROM、尺偏-桡偏ROM、旋前-旋后ROM 均显著改善（P＜0.05）。末次随访时，SBT 组VAS 评分、尺偏-桡偏ROM 显著优于DBT 组（P＜0.05），DBT 组显著优于CS 组（P＜0.05）。DBT 组Mayo 评分、伸-屈ROM、旋前-旋后ROM 显著优于SBT 组（P＜0.05），SBT 组显著优于CS 组（P＜0.05）。影像方面，与术前相比，末次随访时三组患者尺-桡间距、TFCC 连续性和尺桡隐窝水肿均显著改善（P＜0.05）。末次随访时，DBT 组上述影像指标均显著优于SBT 组（P＜0.05），SBT 组显著优于CS 组（P＜0.05）。[结论] 腕关节镜辅助双骨道固定修复TFCC 损伤（IB 型） 安全有效，优于穿单骨道及关节囊修复技术。

Abstract:

[Objective] To compare the clinical consequence of capsular suture (CS), single bone tunnel repair (SBT) and Y-shaped dou-ble bone tunnels repair (DBT) of Palmer type IB wrist triangular fibrocartilage complex (TFCC) tear. [Methods] A retrospective researchwas conducted on 49 patients who had Palmer type IB TFCC tear repaired arthroscopically in our hospital from June 2014 to September2023. According to the preoperative doctor-patient communication, the patients were divided into three groups. Of them, 14 patients re-ceived CS, 19 received SBT, and 16 cases received DBT. The perioperative period, follow-up and imaging data of the three groups were com-pared. [Results] All patients in the 3 groups were operated on successfully. The CS group was significantly superior to the SBT and DBTgroups in terms of operation time [(106.5±15.4) min vs (170.6±15.7) min vs (163.1±19.2) min, P＜0.001] and intraoperative blood loss [(14.0±3.5) ml vs (50.1±15.8) ml vs (46.7±13.4) ml, P＜0.001], whereas the CS group took significantly longer external fixation time than the SBTgroup and DBT group [(50.1±6.1) days vs (33.6±7.2) days vs (31.9±4.8) days, P＜0.001]. All of them were followed up for (14.0±5.6) monthsin a mean, and the CS group resumed full weight-bearing activity significantly later than the SBT and DBT groups [(55.8±3.1) days vs (45.1±3.3) days vs (37.5±5.5) days, P＜0.001]. The VAS score, Mayo score, extension-flexion ROM, ulnar-radial deviation ROM and pronation-su-pination ROM were significantly improved in three groups over time (P＜0.05). At the last follow-up, the SBT group were significantly betterthan the DBT group in VAS score and ulnar-radial deviation ROM (P＜0.05), while the DBT group was significantly superior to the SBTgroup in terms of Mayo score, extension-flexion ROM and pronation-supination ROM (P＜0.05). Moreover, both DBT and SBT groups weresignificantly better than CS group regarding abovesaid items (P＜0.05). As for imaging, the radioulnar distance, TFCC continuity and radioul-nar recess edema were significantly improved in all the three groups at the last follow-up compared with those preoperatively (P＜0.05),which in the DBT group were significantly better than those of SBT group (P＜0.05), while in SBT group was significantly better than in CSgroup (P＜0.05). [Conclusion] Wrist arthroscope-assisted double-transosseous fixation for type IB TFCC tear was safe and effective, and su-perior to single-transosseous and capsule suture techniques.