韧带残端保留技术对三角纤维软骨复合体深层修复后疗效影响的初步探索

Effect of ligament stump retention technique on deep repair of triangular fibrocartilage complex

目的初步探索韧带残端保留(保残)技术对三角纤维软骨复合体(TFCC)深层修复后临床疗效的影响。方法2022年1月至2023年2月期间青岛大学附属医院运动医学科收治的损伤时间为6~12个月的中度以上下尺桡关节不稳定患者35例;纳入非保残TFCC修复组19例和保残TFCC修复组16例进行比较。统计患者性别、年龄、侧别、TFCC分型、发病时间、手术时间、住院时间、腕关节屈伸度、前臂旋转活动度、握力值、疼痛视觉模拟评分(VAS)、改良的Mayo腕关节评分和下尺桡关节稳定性(DRUJ),并在MRI影像学分析TFCC深层愈合情况等。结果两组术后腕关节旋转角度为140.8°±4.6°比146.1°±4.60°。两组腕关节屈伸角度中位数值为137°比142.5°。两组改良Mayo评分为(84.2±5.8)分比(87.5±5.8)分。DRUJ评分中位数值为9分比11分。两组指标差异均有统计学意义(P<0.05);但两种手术方式的术后握力、VAS评分差异无统计学意义(P>0.05)。MRI评估分级示保残TFCC修复组愈合情况较非保残TFCC修复组好,差异有统计学意义(P<0.05)。结论保留韧带残端修复TFCC深层损伤相比于非保残修复TFCC损伤总体的疗效和预后更好,且下尺桡关节稳定性恢复更佳,患者对手术的满意程度较高,对于TFCC深层损伤患者可以尝试保留韧带残端下TFCC深层锚钉修复技术。

Objective To explore the effect of ligament stump retention on the clinical effect of deep repair of triangular fibrocartilage complex(TFCC).Methods A study was conducted on 35 patients with moderate and above radioulnar joint instability with injury duration of 6-12 months in Department of Sports Medicine,Affiliated Hospital of Qingdao University from January 2022 to February 2023.The patients were divided into non-residual TFCC repair group and residual TFCC repair group according to the surgical method.A total of 19 cases of non-residual TFCC repair group and 16 cases of residual TFCC repair group were included for comparison.Gender,age,side,TFCC classification,time of onset,operation time,length of stay,wrist flexion and extension,forearm rotational range of motion,grip strength,VAS score,improved Mayo wrist score and distal radioulnar joint(DRUJ)were analyzed.The deep healing of TFCC was analyzed by MRI imaging.Results Postoperative wrist rotation Angle[(140.8±4.6)°vs(146.1±4.6)°],median wrist flexion and extension Angle(137°vs 142.5°),modified Mayo score(84.2±5.8 vs 87.5±5.8),median DRUJ score(9 vs 11)were improved;the differences were statistically significant(P<0.05).There was no significant difference in grip strength and VAS score between the two groups(P>0.05).MRI grading showed that the healing of TFCC repair group was better than that of non-TFCC repair group;the difference was statistically significant(P<0.05).Conclusions The overall efficacy and prognosis of TFCC deep injury repair with the preservation of ligament residues are better than those without the preservation of ligament residues.The stability of the lower radioulnar joint is better;and the patients are more satisfied with the surgery.For the patients with TFCC deep injury,the TFCC deep anchor repair technique can be tried.