背景:为了评估临床结果,并确定在三角纤维软骨复合体(TFCC)修复后实施背侧远端尺尺关节(DRUJ)包膜植入的理想指征。
方法:我们对2016年至2021年接受关节镜TFCC修复的患者进行了回顾性研究。纳入标准包括超过6个月的有症状的尺骨中央凹体征和磁共振成像的背侧DRUJ半脱位。将225例患者分为两组:第1组(135例)在“Cross-formTFCC修复”(CR)后进行负电位测试,第2组(90例)在“Cross-formTFCC修复”并通过背侧DRUJ包膜包膜(CRDCI)增强DRUJ稳定性。疼痛视觉模拟量表评分(VAS),握力,改良梅奥腕部评分(MMWS),手腕运动范围(ROM),和患者报告的结局(PROM)在术后至少3年进行评估.
结果:两组均显示疼痛VAS评分显著改善,握力,手腕ROM,MMWS,术前和术后期间的PROMs(均P<0.05)。在“CR”和“CR+DCI”组中,有3.7%和1.1%的患者发生复发性DRUJ不稳定,分别,有显著差异。尽管“CR+DCI”组最初与“CR”组相比ROM较差,随后,两者之间没有显着差异。
结论:背侧DRUJ包膜融合可有效降低术后DRUJ不稳定率,增强握力,并在关节镜TFCC修复后术中电位测试阳性的患者中保持腕部ROM。
BACKGROUND: To assess the clinical outcomes and identify the ideal indication for implementing dorsal distal radioulnar joint (DRUJ) capsular imbrication after triangular fibrocartilage complex (TFCC) repair in cases of DRUJ instability.
METHODS: We conducted a retrospective study on patients who underwent arthroscopic TFCC repair between 2016 and 2021. Inclusion criteria comprised a symptomatic ulna fovea sign for over 6 months and dorsal DRUJ subluxation on magnetic resonance imaging. A total of 225 patients were divided into two groups: Group 1 (135 cases) with a negative ballottement test after \"Cross-form TFCC repair\" (CR) and Group 2 (90 cases) with a positive ballottement test after \"Cross-form TFCC repair\" and augmented DRUJ stability through dorsal DRUJ capsular imbrication (CR + DCI). Pain visual analog scale score (VAS), grip strength, modified Mayo Wrist Score (MMWS), wrist range of motion (ROM), and patient-reported outcomes (PROMs) were assessed for a minimum of 3 years postoperatively.
RESULTS: Both groups showed significant improvements in pain VAS score, grip strength, wrist ROM, MMWS, and PROMs between the preoperative and postoperative periods (all P < 0.05). Recurrent DRUJ instability occurred in 3.7% and 1.1% of patients in the \"CR\" and \"CR + DCI\" groups, respectively, with a significant difference. Despite the \"CR + DCI\" group initially exhibiting inferior ROM compared with the \"CR\" group, subsequently, no significant difference was noted between them.
CONCLUSIONS: Dorsal DRUJ capsular imbrication effectively reduces postoperative DRUJ instability rates, enhances grip strength, and maintains wrist ROM in patients with a positive intra-operative ballottement test after arthroscopic TFCC repair.