腕关节镜修复三角纤维软骨复合体损伤
Arthroscopic Repair of Triangular Fibrocartilage Complex Injury
摘要: 三角纤维软骨复合体(Triangular Fibrocartilage Complex, TFCC)是维持腕关节尺侧稳定性、负荷传导和运动协调的关键结构。其损伤是尺侧腕痛常见原因，可导致远端桡尺关节(Distal Radioulnar Joint, DRUJ)不稳、握力下降和继发性关节炎。随着关节镜技术的发展，TFCC损伤的诊断与治疗已从开放手术向微创化、精准化方向演进。本文系统综述TFCC的解剖与功能、损伤机制、分类体系、诊断方法，并重点探讨关节镜下修复技术的进展、手术入路、修复策略、术后康复及疗效评估，结合近年文献，展望未来发展方向。
Abstract: The triangular fibrocartilage complex (TFCC) is a pivotal structure for maintaining the ulnar stability, load transmission and motor coordination of the wrist joint. Its injury is a common cause of ulnar wrist pain, which may lead to distal radioulnar joint (DRUJ) instability, grip strength reduction and secondary arthritis. With the advancement of arthroscopic techniques, the diagnosis and treatment of TFCC injury have evolved from open surgery toward the direction of minimally invasive and precise intervention. This paper systematically reviews the anatomy and function, injury mechanisms and classification systems of the TFCC as well as its diagnostic methods, and focuses on discussing the advances in arthroscopic repair techniques, surgical approaches, repair strategies, postoperative rehabilitation and efficacy evaluation. Combined with recent literature, the future development directions are also prospected.
文章引用：万玉山, 张俊. 腕关节镜修复三角纤维软骨复合体损伤[J]. 临床医学进展, 2026, 16(3): 2181-2188. https://doi.org/10.12677/acm.2026.1631011

参考文献

[1] Palmer, A.K. and Werner, F.W. (1981) The Triangular Fibrocartilage Complex of the Wrist—Anatomy and Function. The Journal of Hand Surgery, 6, 153-162. [Google Scholar] [CrossRef] [PubMed]
[2] Palmer, A.K. and Werner, F.W. (1984) Biomechanics of the Distal Radioulnar Joint. Clinical Orthopaedics and Related Research, 187, 26-35. [Google Scholar] [CrossRef] 
[3] Trumble, T.E., Gilbert, M. and Vedder, N. (1997) Isolated Tears of the Triangular Fibrocartilage: Management by Early Arthroscopic Repair. The Journal of Hand Surgery, 22, 57-65. [Google Scholar] [CrossRef] [PubMed]
[4] Atzei, A. and Luchetti, R. (2011) Foveal TFCC Tear Classification and Treatment. Hand Clinics, 27, 263-272. [Google Scholar] [CrossRef] [PubMed]
[5] Thiru · Pathi, R.G., Ferlic, D.C., Clayton, M.L. and McClure, D.C. (1986) Arterial Anatomy of the Triangular Fibrocartilage of the Wrist and Its Surgical Significance. The Journal of Hand Surgery, 11, 258-263. [Google Scholar] [CrossRef] [PubMed]
[6] Richards, R.S., Bennett, J.D., Roth, J.H. and Milne, K. (1997) Arthroscopic Diagnosis of Intra-Articular Soft Tissue Injuries Associated with Distal Radial Fractures. The Journal of Hand Surgery, 22, 772-776. [Google Scholar] [CrossRef] [PubMed]
[7] Palmer, A.K. (1989) Triangular Fibrocartilage Complex Lesions: A Classification. The Journal of Hand Surgery, 14, 594-606. [Google Scholar] [CrossRef] [PubMed]
[8] Tay, S.C., Tomita, K. and Berger, R.A. (2007) The “Ulnar Fovea Sign” for Defining Ulnar Wrist Pain: An Analysis of Sensitivity and Specificity. The Journal of Hand Surgery, 32, 438-444. [Google Scholar] [CrossRef] [PubMed]
[9] Hermansdorfer, J.D. and Kleinman, W.B. (1991) Management of Chronic Peripheral Tears of the Triangular Fibrocartilage Complex. The Journal of Hand Surgery, 16, 340-346. [Google Scholar] [CrossRef] [PubMed]
[10] Magee, T. (2009) Comparison of 3-T MRI and Arthroscopy of Intrinsic Wrist Ligament and TFCC Tears. American Journal of Roentgenology, 192, 80-85. [Google Scholar] [CrossRef] [PubMed]
[11] Iordache, S.D., Rowan, R., Garvin, G.J., Osman, S., Grewal, R. and Faber, K.J. (2012) Prevalence of Triangular Fibrocartilage Complex Abnormalities on MRI Scans of Asymptomatic Wrists. The Journal of Hand Surgery, 37, 98-103. [Google Scholar] [CrossRef] [PubMed]
[12] Trehan, S.K., Wall, L.B., Calfee, R.P., Shen, T.S., Dy, C.J., Yannascoli, S.M., et al. (2018) Arthroscopic Diagnosis of the Triangular Fibrocartilage Complex Foveal Tear: A Cadaver Assessment. The Journal of Hand Surgery, 43, 680.e1-680.e5. [Google Scholar] [CrossRef] [PubMed]
[13] Cober, S.R. and Trumble, T.E. (2001) Arthroscopic Repair of Triangular Fibrocartilage Complex Injuries. Orthopedic Clinics of North America, 32, 279-294. [Google Scholar] [CrossRef] [PubMed]
[14] Wysocki, R.W. and Ruch, D.S. (2010) Outside-In Repair of Peripheral Triangular Fibrocartilage Complex Tears. Operative Techniques in Sports Medicine, 18, 163-167. [Google Scholar] [CrossRef] 
[15] Yao, J. (2011) All-Arthroscopic Repair of Peripheral Triangular Fibrocartilage Complex Tears Using Fast-Fix. Hand Clinics, 27, 237-242. [Google Scholar] [CrossRef] [PubMed]
[16] Sagerman, S.D. and Short, W. (1996) Arthroscopic Repair of Radial-Sided Triangular Fibrocartilage Complex Tears. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 12, 339-342. [Google Scholar] [CrossRef] [PubMed]
[17] Papapetropoulos, P.A., Wartinbee, D.A., Richard, M.J., Leversedge, F.J. and Ruch, D.S. (2010) Management of Peripheral Triangular Fibrocartilage Complex Tears in the Ulnar Positive Patient: Arthroscopic Repair versus Ulnar Shortening Osteotomy. The Journal of Hand Surgery, 35, 1607-1613. [Google Scholar] [CrossRef] [PubMed]
[18] Chu-Kay Mak, M. and Ho, P. (2017) Arthroscopic-Assisted Triangular Fibrocartilage Complex Reconstruction. Hand Clinics, 33, 625-637. [Google Scholar] [CrossRef] [PubMed]
[19] del Piñal, F., García-Bernal, F.J., Pisani, D., Regalado, J., Ayala, H. and Studer, A. (2007) Dry Arthroscopy of the Wrist: Surgical Technique. The Journal of Hand Surgery, 32, 119-123. [Google Scholar] [CrossRef] [PubMed]
[20] Silber, Z.S., Donnelly, J.C., Farias, M.J., Lama, C.J., Luther, L.I., Kosinski, L.R., et al. (2022) Return to Activity after Arthroscopically Assisted Triangular Fibrocartilage Complex Repair: A Systematic Review. Clinical Journal of Sport Medicine, 33, 270-275. [Google Scholar] [CrossRef] [PubMed]
[21] Liu, E.H., Suen, K., Tham, S.K. and Ek, E.T. (2020) Surgical Repair of Triangular Fibrocartilage Complex Tears: A Systematic Review. Journal of Wrist Surgery, 10, 070-083. [Google Scholar] [CrossRef] [PubMed]
[22] Zhou, J.Y., Tuyishime, H. and Yao, J. (2024) Arthroscopic-Assisted Repair of the Triangular Fibrocartilage Complex. Journal of Hand Surgery Global Online, 6, 445-457. [Google Scholar] [CrossRef] [PubMed]
[23] Atzei, A., Luchetti, R., Carletti, D., Marcovici, L.L., Cazzoletti, L. and Barbon, S. (2021) The Hook Test Is More Accurate than the Trampoline Test to Detect Foveal Tears of the Triangular Fibrocartilage Complex of the Wrist. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 37, 1800-1807. [Google Scholar] [CrossRef] [PubMed]
[24] Eladawi, S., Balamoody, S., Amerasekera, S. and Choudhary, S. (2021) 3T MRI of Wrist Ligaments and TFCC Using True Plane Oblique 3D T2 Dual Echo Steady State (DESS) – A Study of Diagnostic Accuracy. The British Journal of Radiology, 95, Article ID: 20210019. [Google Scholar] [CrossRef] [PubMed]
[25] Corso, S.J., Savoie, F.H., Geissler, W.B., Whipple, T.L., Jiminez, W. and Jenkins, N. (1997) Arthroscopic Repair of Peripheral Avulsions of the Triangular Fibrocartilage Complex of the Wrist: A Multicenter Study. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 13, 78-84. [Google Scholar] [CrossRef] [PubMed]
[26] Pederzini, L.A., Tosi, M., Prandini, M. and Botticella, C. (2007) All-Inside Suture Technique for Palmer Class 1B Triangular Fibrocartilage Repair. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 23, 1130.e1-1130.e4. [Google Scholar] [CrossRef] [PubMed]
[27] Shapiro, L.M. and Yao, J. (2021) Triangular Fibrocartilage Complex Repair/Reconstruction. Hand Clinics, 37, 493-505. [Google Scholar] [CrossRef] [PubMed]
[28] Anderson, M.L., Larson, A.N., Moran, S.L., Cooney, W.P., Amrami, K.K. and Berger, R.A. (2008) Clinical Comparison of Arthroscopic versus Open Repair of Triangular Fibrocartilage Complex Tears. The Journal of Hand Surgery, 33, 675-682. [Google Scholar] [CrossRef] [PubMed]

为你推荐