摘要目的 探讨腕关节镜辅助下修复下尺桡关节(DRUJ)稳定或轻度不稳ⅠB型(Palmer分型)三角纤维软骨复合体(TFCC)损伤的疗效. 方法 采用回顾性病例系列研究分析2015年5月-2017年8月收治的42例单纯ⅠB型TFCC损伤患者临床资料,其中男17例,女25例;年龄18 ～64岁,平均38岁.左侧20例,右侧22例.术中腕关节镜下探查明确为ⅠB型损伤后予关节清理,3-0普迪斯缝线outside-in法修复TFCC.术后过肘长臂石膏托前臂旋转中立位固定3周,后更换短臂石膏托继续固定腕关节2～3周.比较术前和末次随访时的视觉模拟评分(VAS)、握力、关节活动度、改良Mayo腕关节功能评分及上肢功能障碍评定量表(DASH)评分.结果 患者均获随访6～ 24个月,平均11个月.术后无感染、神经损伤发生.末次随访时,13例腕关节疼痛症状完全消失,29例仍有轻度活动时疼痛.末次随访时的VAS由术前(2.7±0.9)分降至(1.2±1.0)分(P＜0.05);握力由术前(20.6±8.3)kg提高至(22.5±8.5)kg(P ＜0.05);腕关节屈伸、桡尺偏及前臂旋转分别由术前的(116.4±26.0)°、(36.7±10.7)°、(137.9 ±29.1)°提高至(119.4±22.8)°(P＞0.05)、(40.0±10.6)°(P＜0.05)、(148.9±21.4)°(P＜0.05);改良Mayo腕关节功能评分由术前(67.3±9.6)分提高至(84.4±6.7)分(P＜0.05),其中优13例,良24例,可5例,优良率为88％;DASH评分由术前(34.6±10.2)分改善至(10.4±6.5)分(P＜0.05). 结论 对于DRUJ稳定或轻度不稳ⅠB型TFCC损伤,采用腕关节镜下滑膜清理加关节囊修复,结合积极康复训练,可有效减轻腕关节疼痛,提高腕关节桡尺偏及前臂旋转活动度和握力,改善腕关节功能.

abstractsObjective To evaluate the effect of wrist arthroscopy-assisted repair of stable or slightly unstable type Ⅰ B triangular fibrocartilage complex (TFCC) injury of distal radio-ulnar joint (DRUJ).Methods A retrospective case series study was conducted to analyze the clinical data of 42 patients with type Ⅰ B TFCC injuries admitted from May 2015 to August 2017,including 17 males and 25 females,aged 18-64 years,with an average of 38 years.Among the patients,20 were injured on the left side,and 22 on the right side.During the operation,if the injury was diagnosed as type Ⅰ B injury under wrist arthroscopy,outside in method with 3-0 purdis stitch was adopted to repair TFCC after joint cleaning.After the operation,the wrist joint was fixed in a neutral rotation position for 3 weeks with a long arm plaster over the elbow and then replaced with a short arm plaster for 2-3 weeks.Visual analogue scale (VAS),grip strength,joint mobility,modified Mayo wrist function score,and disabilities of arm,shoulder and hand score (DASH) before operation and at the last follow-up were compared.Results All patients were followed up for 6-24 months,with an average of 11 months.No infection or nerve injury occurred after operation.At the last follow up,wrist pain disappeared in 13 cases completely,while 29 cases still had pain during moderate activities.VAS was decreased from preoperative (2.7 ± 0.9) points to (1.2 ± 1.0) points (P ＜ 0.05).The grip strength was increased from preoperative (20.6 ± 8.3) kg to postoperative (22.5 ± 8.5) kg (P ＜ 0.05).The wrist flexion and extension,radial ulnar deviation,and forearm rotation were increased from preoperative (116.4 ± 26.0) °,(36.7 ± 10.7) °,and (137.9 ±29.1) ° to postoperative (119.4 ± 22.8) ° (P ＞ 0.05),(40.0 ± 10.6) ° (P ＜ 0.05),and (148.9 ±21.4) ° (P ＜ 0.05).The modified Mayo wrist function score increased from preoperative (67.3 ±9.6) points to postoperative (84.4 ± 6.7) points.The results were excellent in 13 cases,good in 24,and fair in five,with an excellent and good rate of 88％.The DASH score decreased from (34.6 ± 10.2)points to (10.4 ± 6.5) points after operation (P ＜ 0.05).Conclusion For patients with stable or slightly unstable type ⅠB TFCC injury of DRUJ,synovial membrane cleaning under wrist arthroscopy plus capsule repair combined with active rehabilitation training can effectively reduce wrist pain,and improve wrist radial ulnar deviation,forearm rotation and grip strength as well as improve wrist joint function.