| BackgroundThe triangular fibrocartilage complex(TFCC),located at the ulnar side of the wrist,functions to stabilize the distal radial ulnar joint(DRUJ)and the carpal joint,and also serves as a shock absorber for load transmission of the wrist.TFCC injury is one of the most common causes of ulnar wrist pain,which can be manifested as the wrist pain,pain is more obvious during rotation,limited movement,decreased grip strength,etc.TFCC injuries are traumatic and degenerative,traumatic type 1 and degenerative type 2.The ulnar side of TFCC is divided into proximal and distal parts,in which the proximal end is composed of the deep layer of RUL and stops at the fovea of the ulna.The main function is to stabilize DRUJ and form a sling-like structure at the distal end,and the function is to absorb and transfer the ulnar load.Type Palmer IB injury is classified into type 5 according to the structural damage of deep and shallow TFCC and cartilage condition.In this paper,the fully torn of type Palmer IB,Atzei 2 damage can be repaired.These injuries were managed conservatively for the first 3 months,changing daily activities,using temporary splints or plaster immobilization,along with non-steroidal anti-inflammatory drugs.Patients with severe symptoms require a combination of hormone injections and physical therapy.If conservative treatment fails and there are no contraindications to surgery,surgical treatment is recommended.In the past,open surgical repair has been successful.In recent years,with the popularization and development of wrist arthroscopy,arthroscopy has become the gold standard for TFCC injury diagnosis and the mainstream treatment of TFCC injury due to its advantages of minimally invasive,visualization and less dissection of surrounding tissue.At present,there are many surgical methods to repair the deep TFCC stop by arthroscopy,such as the bone and bone anchor technology,and the bone is divided into single bone hole、double bone hole、the radial ulnar ligament(RUL)specific repair of the double bone hole etc.There is currently no agreement on the best surgical procedure.The clinical study of the transverse bone penetration below the ulna recess group and bone anchor technique.According to the author,the advantages of repairing TFCC with the transverse bone penetration below the ulna recess group includes: no need to open the joint capsule;the repaired tendon bone interface is large,it can be applied to patients without closed epiphyseal;simple operation and short operation time;and better DRUJ stabilityObjectiveTo explore the clinical efficacy of two minimally invasive methods of the transverse bone penetration below the ulna recess group and bone anchor group in wrist arthroscopy repair the insertion of TFCC.MethodsA retrospective analysis of 31 patients admitted to our hospital from October 2019 to February 2022,diagnosed by wrist arthroscopy with IB Atzei 2 TFCC injury with DRUJ joint instability,included 17 men and 14 women with a mean age of 40 years(20– 56 years).Randomization according to the randomization table,16 the transverse bone penetration below the ulna recess group(group A)and 15 the bone anchor group(Group B).After surgery,the forearm was fixed through the elbow,the forearm was fixed at 45°,fixed for 3 weeks.After 3 weeks,the forearm was changed to short arm cast,the forearm was neutral position,and the time was fixed for 3 weeks.Systematic rehabilitation training was performed after 6 weeks.Patients were followed at 6 and 12 months after surgery and at 1-year intervals thereafter.Analyze and compare the two groups and last wrist mobility,grip strength,Mayo score,DASH score,VAS pain score,and DRUJ stability score at the last visit before and over 1 year after surgery to evaluate the postoperative effect.29 patients met the inclusion criteria and entered the statistical analysis,where the data of preoperative and postoperative wrist mobility,grip strength,Mayo score,DASH score,VAS pain score,and DRUJ stability score were analyzed by T-test.ResultsThe average postoperative follow-up time of all cases was 17 months(12-36months),of which one patient was lost to follow-up and one follow-up time was less than 1 year.The surgical data of these two patients not included in the statistical analysis.The final follow-up results were used for the post-surgical effect evaluation.1.Results of intra-group comparison between the two groups:(1)Compared the results of the preoperative visit with the last postoperative visit:1)The comparison of wrist mobility,grip strength,Mayo,VAS pain,and DRUJ stability scores in the transverse bone penetration below the ulna recess group(Group A),postoperative scores were significantly improved compared with preoperative scores,the difference was statistically significant(P <0.05).2)Comparison of wrist mobility,grip strength,Mayo,DASH,VAS pain and DRUJ stability scores in bone anchor(Group B)within the group,postoperative scores were significantly improved compared with preoperative scores,the differences were statistically significant(P <0.05).2.Comparison results between the two groups:Compared with the transverse bone penetration below the ulna recess group(Group A)and the bone anchor group(Group B):In terms of operation time,the operation time in the transverse bone penetration below the ulna recess group(Group A)was shorter than the bone anchor group(Group B),and the difference was statistically significant(P <0.05) the last postoperative visit of wrist mobility,grip strength,Mayo score,DASH score and VAS pain score,no differences were statistically significant between the two groups.(P> 0.05).However,the DRUJ stability score was higher in the transverse bone penetration below the ulna recess group(group A)than in the bone anchor group(group B),and the difference was statistically significant(P <0.05).ConclusionIn the treatment of TFCC stop repair by wrist arthroscopy,transverse translucency below ulnar fossa and bone anchor can both play a good correction effect,maximize the recovery of the anatomical structure of TFCC,effectively relieve joint pain,restore and improve joint function.Transverse transversion technique under carpal ulnar fovea for the repair of TFCC fovea insertion tear is more advantageous because it does not need to open the joint capsule,the repaired tendon bone interface is large,the operation is simple,the operation time is short,and the DRUJ has better stability. |
PDF Full Text Request