重视腕关节骨与韧带损伤微创化与精准化治疗

Emphasis on minimally invasive and precise treatment of wrist bone and ligament injuries

腕关节是生活和工作中使用频率最高的关节之一,腕关节骨与韧带损伤会严重影响生活自理、学习工作和运动健身等能力。腕关节尺寸较小但组成复杂,骨与韧带结构比较精细,传统的开放性手术会增加对这些结构或其血供造成破坏的风险,因而恢复效果受限。随着小关节内窥镜相关器械及技术的发展,腕关节镜辅助下的韧带损伤修复、关节内骨折复位固定、骨不连植骨固定、复杂骨折的复位固定等微创手术技术逐步出现,腕关节骨与韧带损伤的治疗走向微创化。应用新兴的3D打印导板技术、导航技术对传统手术技术进行改良,使得腕关节骨与韧带损伤的治疗变得更加精准。因而,腕关节骨与韧带损伤的外科手术技术发展趋势更加微创和精准,以降低医源性损伤的程度和风险,提高手术疗效。腕关节镜技术已成为腕关节骨与韧带损伤的外科诊治中必不可少的工具,是手外科医师的必备技能。笔者对腕关节骨与韧带损伤的骨折固定及韧带修复等手术技术在微创化和精准化方面的进展进行阐述,为临床工作提供参考。

Wrist is one of the most frequently used joints in life and work.Wrist injury will seriously affect the ability of self care,study,work,exercise and fitness.The wrist is small in size but complex in composition,so the bone and ligament structures are relatively fine.Traditional open surgery increases the risk of damage to these structures or their blood supply,and thus the recovery effect is limited.With the development of small arthroscopy related instruments and techniques,minimally invasive surgery techniques such as ligament injury repair,reduction and fixation of intra articular fractures,fixation of nonunion bone grafts,and reduction and fixation of complex fractures have emerged,which made the treatment of wrist and ligament injury minimally invasive.The application of the 3D printing guide technology and navigation technology modifies the traditional surgical techniques,as making the treatment of wrist bone and ligament injuries more minimally invasive and precise to reduce the degree and risk of iatrogenic injury and improve the curative effect.Wrist arthroscopy has become an indispensable tool in the surgical diagnosis and treatment of wrist and ligament injuries,and is an essential skill for hand surgeons.The authors introduce the progress of minimally invasive and precise surgical techniques of fracture fixation and ligament repair for wrist bone and ligament injuries,which provides a reference for clinical work.