镜下穿双骨道修复三角纤维软骨复合体△

Arthroscopic repair of wrist triangular fibrocartilage complex by double transosseous tunnel sutures

摘要:

[目的] 介绍镜下穿“Y”形双骨道固定技术修复三角纤维软骨复合体Palmer IB 型损伤的手术技术和初步临床结果。[方法] 2021 年6 月—2022 年2 月采用腕关节镜下双骨道固定方式修复三角纤维软骨复合体（triangular fibrocartilage com-plex, TFCC） 损伤患者6 例。先行关节镜下清创术，清理滑膜及纤维血管肉芽组织，清晰显露TFCC，于尺骨茎突尺掌侧缘距离软骨面约3 cm 进针钻洞制备“Y”形双骨道，镜下双线进骨道缝合固定掌侧、背侧的深支与浅支，从而修复三角纤维软骨复合体。[结果] 6 例患者均顺利完成手术，无严重并发症，随访时间平均（10.2±3.5） 个月。与术前相比，末次随访时VAS 评分[(3.3±1.2), (1.3±0.8), P＜0.001]、Mayo 评分[(43.0±6.1), (92.7±3.4), P＜0.001]、腕伸-屈活动度（range of motion, ROM） [(100.7±8.6)°,(152.3±5.5)°, P＜0.001]、尺桡偏ROM [(17.8±5.0)°, (36.2±2.1)°, P＜0.001]、旋转ROM [(114.5±10.3)°, (158.8±2.2)°, P＜0.001] 均显著改善。末次随访时X 线片示应力下尺桡间隙为（2.3±0.6） mm，腕关节MRI 提示TFCC 连续性均存在。[结论] 腕关节镜辅助穿骨双隧道缝合修复IB 型TFCC 损伤安全可靠，可以明显改善患者腕关节功能。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic repair of wrist triangular fi-brocartilage complex (TFCC) by sutures through the double transosseous tunnels in Y shape. [Methods] From June 2021 to February 2022,6 patients underwent abovementioned surgical procedures for type IB TFCC tear. First all, arthroscopic debridement was performed withsynovium and fibrovascular granulation tissue removed, and TFCC clearly exposed. The "Y" shaped double transosseous tunnels was pre-pared by drilling Kirschner wires into the volar border of the ulna styloid ulnar about 3cm away from the cartilage surface. As double bundleof sutures were introduced through the bone tunnels, the deep and superficial, or the volar and dorsal portions of the TFCC were threadedunder the arthroscope, and fixed by fastening the sutures. [Results] All the 6 patients successfully completed the operation without seriouscomplications, and followed up for (10.2±3.5) months on an average. Compared with those preoperatively, VAS scores [(3.3±1.2), (1.3±0.8),P＜0.001], Mayo score [(43.0 ±6.1), (92.7±3.4), P＜0.001], wrist extension-flexion range of motion (ROM) [(100.7±8.6)°, (152.3±5.5)°, P＜0.001], ulnar radial deviation ROM [(17.8±5.0)°, (36.2±2.1)°, P＜0.001], forearm rotation ROM [(114.5±10.3)°, (158.8±2.2)°, P＜0.001] weresignificantly improved at the latest follow-up. Furthermore, the radioulnar space under stress X-ray was of (2.3±0.6) mm, with well integri-ty of TFCC revealed by MRI at the latest interview. [Conclusion] This wrist arthroscopy assisted suture of type IB TFCC tear with doubletransosseous tunnels in Y shape is safe and reliable, and can significantly improve the wrist joint function of the patients.