尺骨撞击综合征的关节镜治疗

Arthroscopic treatment of ulnar impaction syndrome

目的探讨尺骨撞击综合征的影像学特征、关节镜诊断、治疗方法及疗效。方法2006年9月至2014年4月收治尺骨撞击综合征患者41例，男28例，女13例；年龄15-52岁，平均（34．5±3．9）岁。术前腕关节掌屈44．17°±6．22°，背伸42．72°±3．37°，桡偏17．45°±4．11°，尺偏19．12°±3．70°，旋前66．81°±4．28°，旋后70．27°±5．30°。于关节镜下探查尺骨变异、腕部骨坏死、关节软骨损伤及三角纤维软骨复合体损伤情况，行滑膜清理。对33例关节软骨损伤者同时行软骨成形，对16例月骨和三角骨囊性坏死者行钻孔减压，对30例三角纤维软骨复合体损伤者行三角纤维软骨复合体成形，对26例尺骨阳性变异者行尺骨头部分磨除短缩。术后3、6、12个月门诊复查，术后1年评估腕关节掌屈、背伸、桡偏、尺偏、旋前、旋后活动度，并采用Green—O’Brien法进行腕关节功能评定。结果术后切口均一期愈合，无神经、血管损伤和感染并发症发生。患者均获得随访，随访时间12-36个月，平均17．5个月。术后1年随访时腕关节活动度均较术前有所增加，掌屈49．13°±3，47°、背伸47．13°±2．39°、桡偏19．33°±3．29°、尺偏25．17°±4．89°、旋前75．73°±7．66°、旋后77．22°±4．89°，与术前比较差异均有统计学意义（P〈0．05）。Green—O’Bfien功能评定优21例、良17例、可3例，优良率93％。结论腕关节镜技术不仅有助于尺骨撞击综合征的诊断，同时可行炎性滑膜和病变软骨的清理、骨钻孔减压、三角纤维软骨复合体修复成形及尺骨头磨除短缩，改善腕关节活动范围和功能。

Objective To investigate ulnar impaction syndrome imaging characteristics and wrist arthroseopy in the diagnosis and treatment effects. Methods From September 2006 to April 2014, 41 patients with ulnar impaction syndrome were treated. Of all 41 patients, 28 were male and 13 female with an average age of 34.5±3.9 years old （ranging from 15 to 52 years old）. The preoperative values of wrist range of motion （ROM） were 44.17°±6.22° at volar flexion, 42.72°±3.37° at dorsal extension, 17.45°± 4.11° at radial deviation, 19.12°±3.70° at ulnar deviation, 66.81°±4.28° at pronation, and 70.27°±5.30° at supination. Arthroscopic exploration was conducted in all patients, aiming to observe the ulnar variance, wrist osteonecrosis, articular cartilage damage and triangular fibrocartilage complex tear. Arthroscopic synovectomy were performed in all cases; 33 cases of articular cartilage injury were treated with arthroscopic chondroplasty; 16 cases of osteonecrosis were treated with arthroscopic drilling decompression; 30 cases with tear of TFC were treated with arthroscopic repair; 26 cases with ulna positive mutation were treated with arthroscopic distal ulna resection. Patients were followed at 3, 6, and 12 months after operation. At 12 months follow-up, the values of wrist range of motion was evaluated for volar flexion, dorsal extension, radial deviation, ulnar deviation, pronation, and supination. GreenO＇Brien method was used to evaluate the function of wrist joint. Results Primary healing was presented in all patients without neurovaseular injury and joint infection. All patients were followed up 12-36 months （mean, 17.5 months）. At 12 months followup, the values of ROM compared with that preoperative increased with significant difference, 49.13°± 3.47° at volar flexion, 47.13°±2.39°at dorsal extension, 19.33°±3.29° at radial deviation, 25.17°±4.89° at ulnar deviation, 75.73°±7.66° at pronation, and 77.22°±4.89° at supination. According to Green-O＇Brien standard, the results were excellent in 21 case, good in 17 cases and fair in 3 case, with 93% excellent and good rate. Conclusion Wrist arthroscopy dose not only contribute to the diagnosis in ulnar impingement syndrome but also can be used in treating inflammatory synovium and cartilage lesions, bone drilling decompression, TFC repair and arthroscopic distal ulna resection with improvement in the range of motion of the wrist joint and function.