关节镜修复联合尺骨截骨治疗合并尺骨正变异的TFCC的临床疗效

Clinical Efficacy of Arthroscopic Repair Combined with Ulnar Osteotomy in the Treatment of Triangular Fibrocartilage Complex Injury with Ulnar Positive Variance

摘要: 目的：评价关节镜下修复联合尺骨短缩截骨术治疗合并尺骨正变异的三角纤维软骨复合体(TFCC)损伤的临床疗效。方法：回顾性分析2022年1月至2023年6月收治的17例患者(19腕)的临床资料。所有患者均接受腕关节镜下TFCC“outside-in”缝合修复联合尺骨斜形截骨短缩内固定术。术后平均随访(48 ± 12)周。采用线性混合效应模型(校正同一患者多腕关节数据的聚类效应)比较术前与术后12个月的上肢功能障碍(DASH)评分、患者自评腕关节(PRWE)评分、改良Mayo腕关节评分及尺骨变异值。为验证结论稳健性，同时进行敏感性分析(仅纳入每名患者首个手术腕，n = 17，采用配对样本t检验)。结果：术后患者尺骨变异值由术前的(3.56 ± 1.34) mm降至(−1.23 ± 1.92) mm (p < 0.001)。DASH评分、PRWE评分均较术前显著降低(p < 0.001)，改良Mayo腕关节评分显著提高(p < 0.001)。敏感性分析结果与主分析一致。术后未发生感染、延迟愈合或骨不连等并发症。结论：对于合并尺骨正变异的TFCC损伤，采用关节镜下修复联合尺骨短缩截骨术治疗，可有效矫正尺骨变异，显著缓解疼痛并改善腕关节功能，临床疗效确切。

Abstract: Objective: To evaluate the clinical efficacy of arthroscopic repair combined with ulnar shortening osteotomy in the treatment of Triangular Fibrocartilage Complex (TFCC) injury with positive ulnar variance. Methods: A retrospective analysis was conducted on the clinical data of 17 patients (19 wrists) treated between January 2022 and June 2023. All patients underwent wrist arthroscopic TFCC repair using the “outside-in” suture technique combined with oblique ulnar shortening osteotomy and internal fixation. The mean follow-up period was (48 ± 12) weeks. A linear mixed-effects model was employed to compare the Disabilities of the Arm, Shoulder and Hand (DASH) score, Patient-Rated Wrist Evaluation (PRWE) score, modified Mayo wrist score, and ulnar variance value between preoperative and 12-month postoperative assessments, while accounting for the clustering effect of data from multiple wrists of the same patient. A sensitivity analysis was performed to verify the robustness of the conclusions (including only the first operated wrist per patient, n = 17, using paired-sample t-tests). Results: Postoperatively, the ulnar variance value significantly decreased from (3.56 ± 1.34) mm to (−1.23 ± 1.92) mm (p < 0.001). Both the DASH and PRWE scores showed significant reduction compared to preoperative levels (p < 0.001), while the modified Mayo wrist score significantly improved (p < 0.001). The results of the sensitivity analysis were consistent with the main analysis. No postoperative complications such as infection, delayed union, or nonunion occurred. Conclusion: For TFCC injury combined with positive ulnar variance, treatment using arthroscopic repair combined with ulnar shortening osteotomy can effectively correct the ulnar variance, significantly alleviate pain, and improve wrist function, demonstrating definite clinical efficacy.