腕关节镜在三角纤维软骨复合体损伤诊治中的应用

三角纤维骨复合体（triangular fibrocartilage complex,TFCC）是桡尺远侧关节和腕尺侧部最重要的稳定结构，它的损伤是引起尺腕痛的确切原因，并且损伤后严重限制了腕关节在工作和运动中的功能。只有对TFCC的解剖结构和生物力学研究有一个十分清晰的认识，才能对TFCC的损伤作出正确的诊断和治疗。     

腕关节镜诊治三角纤维软骨复合体损伤的围术期护理

[目的]总结腕关节镜诊治三角纤维软骨复合体(TFCC)损伤的围术期护理。[方法]对141例TFCC损伤病人行腕关节镜下治疗,同时加强围术期护理。[结果]本组病人手术均获成功,术后随访患侧握力及拇指捏力均达到健侧肢体的70%以上;35例术后出现疼痛,30例出现尺侧一指半麻木,1例出现关节腔内血肿,通过积极的治疗和护理,2d后疼痛消失,1周后麻木感消失,48h后关节腔内血肿消失;1例出现垂腕垂指,经及时干预避免了桡神经的永久性损害。[结论]加强腕关节镜诊治TFCC损伤的围术期护理是手术成功的保证。     

磁共振T2值定量评价健康成年人腕关节三角纤维软骨复合体

目的 探讨磁共振T2 mapping成像技术对健康成年人腕三角纤维软骨复合体(TFCC) 定量评价的可行性。 方法 经知情同意纳入81名健康志愿者（平均年龄23.7±5.3岁)，行腕关节3.0T磁共振冠状位8回波T2 mapping成像。由1名肌骨影像诊断医师在AW 4.6工作站进行后处理，选择桡侧软骨、三角纤维软骨盘（TFC）、纤维血管、类半月板、TFC的尺侧附着处5个感兴趣区（ROI）测量T2值，对比分析各ROI间T2值的差异及不同性别间、利手与非利手间T2值差异。 结果 所纳样本桡侧软骨、TFC、纤维血管、类半月板、TFC尺侧附着处T2值范围分别为（41.37±7.04） ms、（29.8±7.23） ms、（34.22±6.85） ms、（39.26±8.88）ms、（32.57±7.23）ms，总体差异有统计学意义（F=32.235，P＜0.01）。除了纤维血管组织与TFC尺侧附着处、软骨与类半月板之间T2值无统计学差异，其他ROI之间T2值差异有统计学意义（P＜0.05）。不同性别间、利手与非利手T2值差异均无统计学意义(P＞0.05)。 结论 T2 mapping 成像技术可以评价TFCC软骨成分的变化, 对定量评价早期腕关节软骨退变具有潜在的临床价值。     

腕关节镜辅助治疗老年桡骨远端骨折合并三角纤维软骨复合体损伤

目的 探讨腕关节镜结合切开复位内固定治疗老年桡骨远端骨折合并三角纤维软骨复合体损伤的临床疗效.方法 回顾性分析2018年1月至2020年1月河南省洛阳正骨医院(河南省骨科医院)关节镜科收治的68例老年桡骨远端骨折患者,按手术方法分组,治疗组(n=33)给予腕关节镜结合切开复位内固定手术;对照组(n=35)给予切开复位内...     

腕关节不稳合并三角纤维软骨复合体损伤患者早期磁共振成像表现

目的:探讨腕关节不稳合并三角纤维软骨复合体损伤患者早期磁共振成像表现.方法:选取2016年8月—2017年8月我院接收的66例腕关节不稳合并TFCC损伤患者,行MRI检查,观察检查结果.结果:66例TFCC患者,经MRI分析并与手术结果对照发现,Ⅰ型损伤50例;分型情况:ⅠA 9例,ⅠB 23例,ⅠC 4例,ⅠD 14...     

腕关节镜下经骨隧道修复与outside-in缝合术在腕三角纤维软骨复合体损伤修复中的应用效果对比

目的 比较腕关节镜下经骨隧道修复与outside-in缝合术在腕三角纤维软骨复合体（TFCC）损伤修复中的应用效果。方法 选取于淄博一四八医院2019年1月至2021年12月治疗的TFCC损伤患者96例,根据组间基线特征匹配的原则,采用随机数字表法分为观察组48例和对照组48例。予以观察组腕关节镜下经骨隧道修复治疗;予以对照组outside-in缝合术治疗。观察期间,观察组和对照组各剔除3例患者,两组最终各有45例患者参与本次研究。对比两组术前与术后的腕关节功能、腕关节活动度与术后并发症发生率。结果 两组患者术前疼痛、功能状态、活动范围及握力评分差异无统计学意义（P>0.05）;术后6个月,两组患者疼痛、功能状态、活动范围及握力评分均明显升高,且观察组患者高于对照组,差异有统计学意义（P<0.05）。两组患者术前腕关节屈伸和旋转活动度比较差异无统计学意义（P>0.05）;术后6个月,两组腕关节屈伸和旋转活动度均明显升高,且观察组患者高于对照组,差异有统计学意义（P<0.05）。两组患者术后并发症总发生率观察组低于对照组,但组间差异无统计学意义（P>0.05...     

一种用于三角纤维软骨复合体损伤后固定的新型低温热塑肘腕手矫形器的研发与初步效果测试

目的：开发一种用于三角纤维软骨复合体损伤后固定的新型低温热塑肘腕手矫形器（LTTEWHO）,并评估其对前臂和肘关节活动的影响。方法：结合石膏固定和Sugartong矫形器的特点,开发新型LTTEWHO,并招募8名健康受试者依次进行石膏固定、Sugartong矫形器佩戴和新型LTTEWHO的穿戴评测。采集所有受试者未佩戴矫形器时的前臂旋前旋后和肘关节屈伸主动关节活动范围（AROM）作为基线信息,并分别测量3种不同固定方式下受试者前臂最大旋前旋后AROM、感受到阻力时的关节活动范围（ROM）以及感受阻力时肘关节屈伸AROM。结果：前臂最大旋前AROM比例比较,Sugartong 石膏和LTTEWHO均小于Sugartong矫形器;阻力点旋前AROM比例比较,Sugartong 石膏和LTTEWHO均小于Sugartong矫形器（P＜0.05,0.01）;旋后AROM比例比较,3种固定方式依次为Sugartong 石膏＜ LTTEWHO ＜Sugartong矫形器（P＜0.05,0.01）;阻力点旋后AROM比例比较,Sugartong 石膏明显＞Sugartong矫形器（P＜0.01）。Sugartong 石膏和Sugartong矫形器固定方式的阻力点屈伸AROM比例均＞LTTEWHO（P<0.01）。结论：本研究设计的新型 LTTEWHO能够起到较好地限制前臂旋前旋后的作用,其固定效率较目前的Sugartong矫形器更优。     

基于MRI影像组学模型识别三角纤维软骨复合体损伤

目的 构建腕关节三角纤维软骨复合体（triangular fibrocartilage complex, TFCC）的MRI影像组学模型,评价其对TFCC损伤的诊断效能。材料与方法 回顾性分析2019年1月至2021年12月于吉林大学中日联谊医院放射线科行腕关节磁共振检查的100例患者病例（损伤及非损伤各50例）,所有患者均行高分辨率3.0 T磁共振扫描,选取T2WI冠状位序列,手动勾画图像中的TFCC区域,提取影像特征,采用曼-惠特尼U检验（Mann-Whitney U test）及最小绝对收缩和选择算子（least absolute shrinkage and selection operator, LASSO）算法进行数据降维、特征筛选,将所筛选出的相关性最强的影像特征采用支持向量机（support vector machine, SVM）的建模方法建立分类模型,采用受试者工作特征（receiver operating characteristic, ROC）曲线的曲线下面积（area under the curve, AUC）、精确度、敏感度和特异度评价模型的诊断效能。结果 从...     

踝关节软骨损伤关节镜术后的综合康复治疗

目的：探讨踝关节软骨损伤关节镜术后综合康复治疗的有效方法。方法：选择84例行踝关节镜手术的患者,随机分为综合组、运动组和对照组,每组28例。综合组行关节腔内注射透明质酸钠联合运动疗法;运动组只行运动疗法;对照组术后仅行骨科常规的护理治疗,不给予康复干预。分别于手术前后进行踝关节JOA踝关节功能评分,并且在术后6个月时按照Kofoed法进行疗效评价。结果：术前术后患者JOA功能评分差异具有显著性（P〈0．05）。按照Kofoed法,术后6月,综合组、运动组的疗效优良率明显高于对照组（P〈0．05）。结论：踝关节软骨损伤关节镜术后的患者应用关节内注射透明质酸钠联合运动疗法,对缓解关节疼痛和促进关节功能的早期恢复具有显著疗效。     

三角纤维软骨复合体（TFCC）损伤的腕关节镜诊治

目的对外伤性腕关节三角纤维软骨复合体（TFCC）损伤关节镜治疗后疗效评价。方法选有急慢性外伤史的6例腕关节三角纤维软骨复合体损伤病例,本组6例患者,男2例,女4例,年龄19—49岁,平均36．7岁,其中IA型2例,IB型3例,IIC型1例。经物理检查及MRI检查有异常者施行关节镜检查,其中3例TFCC中心性撕裂在关节镜下行游离边缘切除术,3例TFCC边缘部撕裂施行缝合修复术,术后随访1～12个月。利用Green-O’Brien功能评定方法。结果优5例,良1例。其中5例疗效好的已恢复原来工作。结论对腕关节三角纤维软骨复合体损伤关节镜治疗是可以明确诊断并且手术效果明确创伤小的一种手术方法     

The effect of triangular fibrocartilage complex injury on extensor carpi ulnaris function and friction

Background

It has been previously shown that injury to the triangular fibrocartilage complex increases the moment arm of the extensor carpi ulnaris. This will reduce the force producing capacity of the muscle in some situations, but will also increase its mechanical advantage. It is also possible that the change in the tendon path may increase tendon friction, predisposing the patient to future repetitive motion injury. It is the purpose of this study to determine the effects of triangular fibrocartilage complex injury on extensor carpi ulnaris moment producing capacity and tendon friction.

Methods

A simple simulation was used to examine muscle moment producing capacity throughout the range of motion, at varying speeds and in both injured and healthy states. Six fresh frozen human cadaveric wrists were used to determine the effect of injury on tendon friction. A custom made device was used to move the wrists through a range of motion, while a constant force was applied to the proximal tendon and force was recorded at the distal tendon. Friction was measured before and after the creation of injury.

Findings

The decreases in muscle force following injury were small, even in the worse case. The moment producing capacity of the muscle was increased following injury. Tendon friction during flexion–extension was decreased following injury. The friction during radial-ulnar deviation was unchanged.

Interpretation

When making surgical decisions about triangular fibrocartilage complex repair, it is not necessary to consider extensor carpi ulnaris moment producing capacity or tendon friction.     

Normal ultrasound anatomy of the triangular fibrocartilage of the wrist: a study on cadavers and on healthy subjects

PURPOSE: To report the normal sonographic anatomy of the triangular fibrocartilage (TFC) of the wrist in cadavers and volunteers. METHOD: Five hands from cadavers were examined sonographically before and after wrist dissection, during which the TFC was marked with surgical wires. Twenty volunteers without wrist limitation or pain, and without any history of wrist disease or inflammatory arthritis (mean age, 26 years (range,19-45 years) were also examined. RESULTS: Sonograms showed that the meniscus and the TFC were clearly separated. The meniscus appeared as a triangular structure that was homogeneous and slightly hyperechoic. Compared with the meniscus, the TFC appeared hypoechoic. The same patterns were observed for cadavers and volunteers. In 3 volunteers (15%), the TFC was not visualized. CONCLUSIONS: Using high-resolution ultrasound systems, the TFC can be separated from meniscus. However, visualization of the TFC remains limited due to its deep location and the presence of acoustic shadowing from bony structures.     

关节镜下肩袖修复术后早期及延迟康复治疗介入的疗效比较

目的:比较全关节镜下肩袖修复术后早期康复锻炼和延迟康复锻炼对肩关节功能和肩袖愈合情况的影响。方法:选取采用全关节镜下双排缝合桥技术修补中、大肩袖撕裂的患者共65例,随机将其分为治疗组33例和对照组32例,治疗组患者术后早期即进行肩关节的康复锻炼,对照组患者采用延迟的肩关节康复锻炼方案。2组患者均于术前、术后6个月、12个月采用简明肩关节功能测试(SST)、欧洲肩关节协会的Constant肩关节评分系统、视觉模拟评分(VAS)和关节活动范围进行肩关节功能评定,并在术后12个月行肩关节磁共振检查,观察肩袖愈合情况。结果:术前,2组患者SST评分、Constant评分、VAS评分、肩关节活动范围的组间差异均无显著性意义(P>0.05);术后6个月、术后12个月时2组患者的SST评分、Constant评分、VAS评分、肩关节前屈、外展外旋均显著优于组内术前评分(P<0.05),肩关节外旋差异无显著性意义(P>0.05);组间各时间点比较,差异均无显著性意义(P>0.05);术后12个月时2组患者的肩袖愈合情况比较,差异无显著性意义(P>0.05)。结论:全关节镜下双排缝合桥技术是一种治疗中、大肩袖撕裂安全有效的方法,术后1年内随访结果表明肩关节早期康复锻炼方案与延迟康复锻炼方案对肩关节功能和肩袖愈合影响类似,长期随访结果有待进一步研究。     

Sonography and sonoarthrography of the scapholunate and lunotriquetral ligaments and triangular fibrocartilage disk: initial experience and correlation with arthrography and magnetic resonance arthrography.

OBJECTIVE: The purpose of this study was to determine the utility of sonography and sonoarthrography in evaluation of dorsal bands of the scapholunate ligament (SLL), lunotriquetral ligament (LTL), and triangular fibrocartilage (TFC) disk in correlation with arthrography and magnetic resonance arthrography (MRA). METHODS: High-resolution sonography of the SLL, LTL, and TFC disk was performed on symptomatic wrists in 16 patients referred by a hand surgeon for MRA of the symptomatic wrists. All patients then underwent arthrography and an MRA study of the same wrist. After MRA, sonography was repeated. The imaging findings of these different techniques were then compared. Four patients (25%) underwent surgery of their wrists. In these 4 patients, the surgical and imaging findings were correlated. RESULTS: For the SLL, the results were concordant for all imaging modalities in 15 patients (93.75%) and partially concordant in 1 (6.25%). For the LTL, the results were concordant for all imaging modalities in 12 patients (75%), partially concordant in 3 (18.75%), and discordant in 1 (6.25%). For the TFC disk, the results were concordant for all imaging modalities in 13 patients (81.25%), partially concordant in 2 (12.5%), and discordant in 1 (6.25%). The arthroscopic and imaging findings were concordant for 3 SLLs, 3 LTLs, and 3 TFC disks. CONCLUSIONS: Our preliminary results are encouraging. Sonography may be used at least as a screening imaging modality in evaluation of the SLL and TFC disk. Sonoarthrography improves evaluation of the LTL.     

肘关节骨折术后康复的研究

目的：比较肘关节骨折术后早期与恢复期开始实施康复治疗的不同疗效。方法：2002年2月-2003年4月我院手术的28例肘关节骨折患者（早期组），术后1—3天开始康复治疗；另一组10例肘关节骨折术后3—6个月后因功能障碍来我科治疗的患者（恢复期组）。两组经系统康复治疗后进行Mayo肘关节评分及ROM评定。结果：早期组Mayo肘关节评分（P〈O．01）、ROM（P〈0．05）均优于恢复期绀，且疗程较短（P〈0．01）。结论：肘关节骨折术后早期系统的康复治疗可最大限度地防止肌肉萎缩、关节粘连，尽快恢复肢体功能，缩短疗程，减轻患者的痛苦及经济负担。     

Guidelines and pitfalls for the rehabilitation following hip arthroscopy

Rehabilitation guidelines following hip arthroscopy have been presented in the literature with common themes consisting of initial protection, restoration of lumbo-pelvic stability, neuromuscular re-education, and return to sport training. The purpose of this review is to present hip arthroscopy guidelines in 4 phases and to address common pitfalls that may delay the rehabilitative process. The goal of phase 1 should be to protect healing tissues through activity modifications. Phase 2 intends to return the patient to pain-free community ambulation without compensation or irritation. A review of hip muscular actions during gait is presented to guide exercise progressions during this phase. Phase 3 should reestablish neuromuscular control through strength and endurance training to provide the foundation for return to functional activities or sports training progressions. The last phase of rehabilitation is dedicated to reestablishing power, speed, agility, and skill for advanced sports and advanced functions.     

屈指肌腱Ⅱ区与V区修复术后早期主动运动方案的疗效对比

目的：观察Ⅱ区与V区屈肌腱修复术后早期康复治疗的疗效。方法：将38例屈肌腱修复术后患者依损伤部位分Ⅱ区组20例（46指）和V区组18例（44指）。2组患者术后均采用背侧石膏托固定、物理因子疗法、运动疗法等治疗。术后12周时进行总主动活动范围测量法（TAM ）和上肢功能指数（UEFI）评定。结果：治疗12周后,V区组TAM优良率及UEFI评分均明显高于Ⅱ区组（P＜0．05）。V区组指间关节伸直缺失明显低于Ⅱ区组（P＜0．01）。结论：屈肌腱修复术后早期采用主动运动方案安全有效,而且V区损伤后手指活动度和日常生活能力的恢复均优于Ⅱ区。     

分米波在手部屈肌腱修复术后康复中的应用分析

目的：探讨分米波防治肌腱粘连的作用与机制。方法：１５０ 例肌腱修复术后患者随机分成对照组和治疗组,术后３ 个月按ＴＡＭ方法进行疗效评定。结果：治疗组Ⅲ～Ⅳ区和Ⅱ区优良率分别为９１．４％ 和８０％ ,明显优于对照组,经统计学处理有显著差异。结论：分米波能抑制肌腱外愈,促进内愈,增加胶原的伸展性,是防治肌腱粘连的重要措施之一