尺骨茎突骨折治疗进展及三角纤维软骨复合体(TFCC)的重要性

Advances in the Treatment of Ulnar Styloid Fractures and the Importance of the Triangular Fibrocartilage Complex (TFCC)

摘要: 尺骨茎突骨折(Ulnar Styloid Fracture, USF)是腕部常见损伤，常合并桡骨远端骨折(Distal Radius Fracture, DRF)，发生率达40%~70%。三角纤维软骨复合体(Triangular Fibrocartilage Complex, TFCC)作为维持下尺桡关节(Distal Radioulnar Joint, DRUJ)稳定的核心结构，其损伤与USF预后密切相关。本文系统综述USF分型演进(以Hauck分型为核心)、手术与非手术治疗进展(张力带/锚钉/钢板技术)、TFCC损伤诊疗革新(关节镜/高分辨率MRI)，并深入分析生物力学机制与临床争议。研究表明：Hauck II型骨折需积极固定以降低DRUJ不稳定风险；TFCC尺侧止点损伤是功能障碍的关键因素，锚钉修复成功率 > 90%；关节镜技术显著提升微创治疗精准度。当前争议集中于II型USF固定必要性、TFCC分型标准化及基层技术推广。未来需结合人工智能、可降解材料及多中心RCT研究，建立个体化治疗路径。

Abstract: Ulnar styloid fractures (USF) are common wrist injuries, frequently associated with distal radius fractures (DRF), occurring in 40%~70% of cases. The triangular fibrocartilage complex (TFCC), as the core structure maintaining distal radioulnar joint (DRUJ) stability, is critically linked to USF prognosis. This systematic review examines the evolution of USF classifications (centered on the Hauck classification), advances in surgical and non-surgical approaches (tension band/anchor/screw techniques), and innovations in TFCC injury diagnosis and management (arthroscopy/high-resolution MRI). It provides an in-depth analysis of biomechanical mechanisms and current clinical controversies. Research indicates: Hauck Type II fractures require active fixation to reduce DRUJ instability risk; TFCC ulnar-sided insertional injuries are a key factor in dysfunction, with anchor repair achieving > 90% success rates; arthroscopic techniques significantly enhance the precision of minimally invasive treatment. Current debates center on the necessity of fixing Type II USF, standardizing TFCC classifications, and disseminating techniques to primary care settings. Future efforts should integrate artificial intelligence, biodegradable materials, and multi-center RCTs to establish individualized treatment pathways.