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  • Title: [Comparative study of short-term effectiveness of three surgical methods for ulnar styloid base fracture complicated with triangular fibrocartilage complex injury].
    Author: Tian Y, Dong J, Wu Y, Tian J, Shang W, Zhang H, Wang X.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2024 Aug 15; 38(8):968-975. PubMed ID: 39175319.
    Abstract:
    OBJECTIVE: To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury. METHODS: A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups ( P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation. RESULTS: All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation ( P<0.05); however, the differences in the change values of the above indexes between groups was not significant ( P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group ( P<0.05), and there was no significant difference between the TFCC group and the combination group ( P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group ( P<0.05); there was no significant difference between the other groups ( P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group ( P<0.05); there was no significant difference between the TFCC group and the combination group ( P>0.05). CONCLUSION: For ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice. 目的: 比较单纯关节镜下缝合三角纤维软骨复合体（triangular fibrocartilage complex，TFCC）、缝合TFCC联合切开复位内固定与单纯切开复位内固定尺骨茎突骨折治疗桡骨远端骨折合并尺骨茎突基底部骨折伴TFCC损伤的近期疗效。. 方法: 回顾性分析2019年9月—2022年9月收治且符合标准的97例桡骨远端骨折合并尺骨茎突基底部骨折并伴TFCC损伤患者临床资料。桡骨远端骨折复位内固定后，37例单纯关节镜下缝合TFCC（TFCC组）、31例缝合TFCC联合切开复位内固定尺骨茎突骨折（联合组）、29例单纯切开复位内固定尺骨茎突骨折（内固定组）。3组患者性别、年龄、受伤侧别、受伤至手术时间以及术前桡骨高度、掌倾角、尺偏角、握力、腕关节旋转活动度、尺桡偏活动度、屈伸活动度等基线资料比较，差异均无统计学意义（ P>0.05）。比较3组患者术前及术后12个月桡骨高度、掌倾角、尺偏角，腕关节旋转活动度、尺桡偏活动度、屈伸活动度及握力差值（变化值），术后12个月采用改良Gartland-Werley评分评价疗效。. 结果: 术后切口均Ⅰ期愈合。患者均获随访，随访时间12～18个月，平均14个月。X线片复查示，TFCC组4例尺骨茎突骨折不愈合，其余患者术后3个月时骨折均愈合；术后12个月3组桡骨高度、掌倾角、尺偏角均优于术前（ P<0.05），但上述指标变化值组间差异均无统计学意义（ P>0.05）。术后12个月，TFCC组、联合组腕关节旋转、尺桡偏、屈伸活动度变化值均优于内固定组（ P<0.05），TFCC组与联合组间差异无统计学意义（ P>0.05）。联合组握力变化值优于内固定组，差异有统计学意义（ P<0.05）；其余组间差异均无统计学意义（ P>0.05）。TFCC组、联合组、内固定组腕关节改良Gartland-Werley评分优良率分别为91.89%（34/37）、93.54%（29/31）、72.41%（21/29）；TFCC组、联合组优良率高于内固定组，差异有统计学意义（ P<0.05）；TFCC组与联合组间差异无统计学意义（ P>0.05）。. 结论: 对于合并TFCC损伤的尺骨茎突基底部骨折，与单纯切开复位内固定相比，关节镜下单纯缝合修复TFCC或联合内固定治疗均有利于术后早期腕关节功能恢复，且两者疗效相似，因此关节镜下单纯修复缝合TFCC可能是更好选择。.
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