| 关节镜下三角纤维软骨复合体修整联合尺骨远端斜形截骨短缩术治疗尺骨撞击综合征 |
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投稿时间：2023-11-13
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| 作者 | Author | 单位 | Address | E-Mail |
| 孟小光 |
MENG Xiao-guang |
唐山市人民医院骨科, 河北 唐山 063000 |
Department of Orthopaedics, Tangshan People's Hospital, Tangshan 063000, Hebei, China |
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| 徐凤松 |
XU Feng-song |
唐山市人民医院骨科, 河北 唐山 063000 |
Department of Orthopaedics, Tangshan People's Hospital, Tangshan 063000, Hebei, China |
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| 史福东 |
SHI Fu-dong |
唐山市人民医院骨科, 河北 唐山 063000 |
Department of Orthopaedics, Tangshan People's Hospital, Tangshan 063000, Hebei, China |
30980973@qq.com |
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| 期刊信息：《中国骨伤》2024年，第37卷，第12期，第1180-1187页 |
| DOI：10.12200/j.issn.1003-0034.20230271 |
| 基金项目:河北省卫生和计划生育委员会科研基金项目(编号:20191615) |
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中文摘要:
目的: 探讨关节镜下三角纤维软骨复合体(triangular fibrocartilage complex,TFCC)修整联合尺骨远端斜形截骨短缩术治疗尺骨撞击综合征的近期临床疗效。
方法: 回顾性分析2017年至2021年收治的49例尺骨撞击综合征患者,其中3例失访,最终46例纳入研究,男23例,女23例;年龄21~53(36.5±3.3)岁。根据手术方式不同分为TFCC组和对照组。TFCC组24例,男13例,女11例;年龄21~53(36.5±3.2)岁;左侧10例,右侧14例;行关节镜下TFCC修整联合尺骨远端斜形截骨短缩术。对照组22例,男10例,女12例;年龄21~53(36.5±3.3)岁;左侧13例,右侧9例;行尺骨远端斜形截骨短缩术。观察并比较两组手术时间、住院时间、术中失血量及截骨愈合时间,分别于术前及术后12个月采用Cooney腕关节功能评分、视觉模拟评分(visual analogue scale,VAS)评估患者腕关节功能及疼痛改善情况,并比较尺骨变异值、握力值变化情况。
结果: TFCC组随访时间12~21(15.10±2.67)个月,对照组随访时间12~20(15.06±2.81)个月,两组随访时间比较,差异无统计学意义(P>0.05)。TFCC组手术时间、截骨愈合时间、术中失血量、住院时间分别为(68.51±13.50) min、(16.21±1.16)周、(25.13±4.22) ml、(7.35±1.20) d,对照组分别为(45.65±5.64) min、(17.46±2.06)周、(24.61±5.10) ml、(7.51±1.13) d,两组手术时间、截骨愈合时间比较,差异有统计学意义(P<0.05);两组术中失血量、住院时间比较,差异无统计学意义(P>0.05)。两组术前Cooney 腕关节功能总分及各项评分比较,差异无统计学意义(P>0.05);术后12个月TFCC组Cooney 腕关节功能评分疼痛、功能状态、活动度、握力及总分高于对照组(P<0.05)。术后12个月根据Cooney腕关节功能评分,TFCC组优16例,良6例,可2例;对照组优7例,良11例,可4例;两组比较,差异无统计学意义(P>0.05);但TFCC组腕关节功能恢复为优的占比高于对照组(P>0.05)。术后12个月,TFCC组VAS(3.41±0.16)分,低于对照组(3.52±0.13)分(P<0.05);两组尺骨变异值比较,差异无统计学意义(P>0.05);TFCC组握力(93.6±10.1)%,优于对照组(83.5±10.3)%(P<0.05)。
结论: 与尺骨远端斜形截骨短缩术相比,关节镜下TFCC修整联合尺骨远端斜形截骨短缩术治疗尺骨骨碰撞综合征手术时间较长,但截骨愈合时间缩短,腕关节功能提高,尤其是疼痛、尺骨变异值、握力及活动度都得到明显改善。 |
| 【关键词】尺骨撞击综合征 尺骨斜形截骨短缩技术 三角纤维软骨复合体 |
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| Arthroscopic triangular fibrocartilage complex trimming combined with oblique osteotomy shortening of distal ulna for ulnar impact syndrome |
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ABSTRACT
Objective To explore clinical effect of arthroscopic modification of triangular fibrocartilage complex (TFCC) combined with oblique osteotomy shortening of distal ulna in treating ulna impact syndrome.
Methods A retrospective analysis was performed on 49 patients with ulnar impingement syndrome admitted from 2017 to 2021,3 patients were lost to follow-up,and 46 patients were finally included in study,including 23 males and 23 females,aged from 21 to 53 years old with an average of (36.5±3.3) years old. The patients were divided into TFCC group and control group according to different operation methods. Twenty-four patients in TFCC group,including 13 males and 11 females,aged from 21 to 53 years old with an average of (36.5±3.2) years old;10 patients on the left side and 14 patients on the right side;arthroscopic TFCC trimming combined with oblique osteotomy shortening of distal ulna was performed. Twenty-two patients in control group,including 10 males,12 females,aged from 21 to 53 years old with an average of (36.5±3.3) years old;13 patients on the left side,9 patients on the right side; oblique osteotomy of distal ulna was performed. Operative time,hospital stay,intraoperative bleeding and osteotomy healing time between two groups were observed and compared. Cooney wrist function score and visual analogue scale (VAS) were used to evaluate improvement of wrist function and pain before and 12 months after operation,respectively. The variation values of ulna and grip strength were compared.
Results The follow-up time of TFCC group ranged from 12 to 21 months with an average of (15.10±2.67) months,and that of control group ranged from 12 to 20 months with an average of (15.06±2.81) months,there was no statistical significance between two groups (P>0.05). Operative time,osteotomy healing time,intraoperative bleeding and hospital stay in TFCC group were (68.51±13.50) min,(16.21±1.16) weeks,(25.13±4.22) ml and (7.35±1.20) d,respectively;while control group were (45.65±5.64) min,(17.46±2.06) weeks,(24.61±5.10) ml and (7.51±1.13) d,respectively; there were statistically significant differences in operative time and osteotomy healing time between two groups (P<0.05). There were no significant differences in intraoperative bleeding and hospital stay between two groups(P>0.05). There were no significant differences in total score and scores of Cooney wrist joint function between two groups before operation(P>0.05). Pain,functional status,range of motion,grip strength and Cooney wrist function score in TFCC group were higher than those in control group at 12 months after operation (P<0.05). According to Cooney wrist joint function score at 12 months after operation,16 patients got excellent results,6 good,and 2 fair in TFCC group; while 7 excellent,11 good and 4 fair in control group;there was no significant difference between two groups (P>0.05). However,the proportion of wrist function recovery in TFCC group was higher than that in control group (P>0.05). At 12 months after operation,VAS of TFCC group (3.41±0.16) was lower than that of control group(3.52±0.13),P<0.005. There was no significant difference in ulnar variation between TFCC group and control group(P>0.05). The grip strength of TFCC group (93.6±10.1)% was better than that of control group (83.5±10.3)% (P<0.005).
Conclusion Compared with oblique osteotomy shortening of distal ulna,TFCC trimming combined with oblique osteotomy shortening of distal ulna took longer to treat ulna collision syndrome,but the osteotomy healing time was shortened and wrist joint function was improved,especially pain,ulna variation,grip strength and motion were significantly improved. |
| KEY WORDS Ulnar impingement syndrome Oblique osteotomy shortening technique of ulna Triangular fibrocartilage complex |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孟小光,徐凤松,史福东.关节镜下三角纤维软骨复合体修整联合尺骨远端斜形截骨短缩术治疗尺骨撞击综合征[J].中国骨伤,2024,37(12):1180~1187 |
| 英文格式: | MENG Xiao-guang,XU Feng-song,SHI Fu-dong.Arthroscopic triangular fibrocartilage complex trimming combined with oblique osteotomy shortening of distal ulna for ulnar impact syndrome[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(12):1180~1187 |
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