腕关节镜下射频皱缩治疗腕骨间韧带部分损伤合并TFCC损伤

Application of arthroscopic radiofrequency shrinkage for treatment of partial intercarpal interosseous ligament injuries combined with TFCC injuries

目的采用腕关节镜辅助射频皱缩技术治疗腕骨间韧带部分损伤合并TFCC（triangular fibrocartilage complex，三角纤维软骨复合体）损伤，并初步评估其治疗效果。方法对8例腕关节疼痛的患者，关节镜检查发现腕骨间韧带部分损伤合并TFCC损伤，予清创后利用射频器对腕骨间韧带和TFCC残缘进行射频皱缩。术后观察其疼痛情况，关节各项活动度，握、捏力，并用改良Mayo腕关节评分及DASH量表评分评估其功能情况。结果术后随访时间平均为10个月（6～12个月）。3例疼痛完全消失，4例疼痛明显减轻，1例尚无明显好转。按改良Mayo腕关节评分：术前平均51．3（30～70），术后平均78．1（45～95）。按DASH量表评分：术前平均39.3（18．3～49．3），术后平均19．2（8．8～28．7）。两种评分术后均较术前有明显改善。术后无关节炎、手背神经损伤等并发症表现。结论关节镜下射频皱缩对腕骨间韧带部分损伤合并TFCC损伤是一种有效的治疗手段。

Objective To evaluate the preliminary results of arthroscopic thermal capsular shrinkage for partial interearpal interosseous hgament injuries combined with TFCC injuries. Methods Eight patients with wrist pain were included in this study. Diagnostic arthroscopy showed partial intercarpal interosseous ligament injuries combined with TFCC injuries in these patients. After debridement using a shaver, a monopolar mdiofrequency probe was used to shrink the intercarpal interosseous ligament and the fringed edges of TFCC. Postoperatively pain, wrist motion, grip and pinch strength were evaluated. Wrist function was assessed using modified Mayo wrist score and DASH questionnaire. Results Follow up interview and examination were conducted 10 months （range 6-12 months） postoperatively. Three with complete relief and 4 with substantial relief. Only in 1 patient the pain remained unchanged. All patients demonstrated a negative scaphoid shift test on postoperative physical examination. The postoperative scores of the Modified Mayo Wrist Score and DASH questionnaire were significantly better than the preoperative scores according to the Wilcoxon signed-rank test （ P 〈 0.05）. Preoperative Mayo score was 51.3（30-70） while postoperative score was 78.1 （45-95）. DASH score ineased from 39.3（18.3-49.3） preoperatively to 19.2（8.8-28.7） postoperatively. Conclusion This study suggests that arthroscopic radiofrequency shrinkage is a valid and safe procedure to treat partial intercarpal interosseous ligament injuries combined with TFCC injuries.