| Purpose:To investigate the clinical effect of wrist arthroscopy through bone tunnel fixation technology in the treatment of TFCC(triangular fibrocartilag complex)Palmer IB and ID type injuries.Methods:Retrospective analysis of arthroscopic treatment of TFCC in the hospital affiliated to Jining Medical College from June 2014 to July 2019 Among 41 cases of IB and ID closed injuries,28 cases had complete follow-up data.According to the operation method,it is divided into two groups,A and B.GrouP A is repaired by wrist arthroscopy with simple joint capsule fixation,and group B is repaired by wrist arthroscopy with bone tunnel fixation technology.TFCC injury side,whether or not combined with ulnar Positive variation,gypsum external fixation time,Preoperative and Postoperative VAS score,Preoperative and Postoperative wrist mobility,hand grip strength,hospitalization costs,rehabilitation time,improved wrist joint Mayo score basic information.All Patients’ wrist arthroscopy surgery was completed by the doctors of this research group after undergoing unified training and strictly following the same operating specifications.All Patient data were collected and collated by the same doctor.SPSS20.0 statistical software was used for statistical analysis of the collected data.Results:The follow-up data of 28 Patients was complete,with an average follow-up of 12.6 ±4.40 months.All the 28 operations were successfully completed under arthroscopy.One of the cases had ulnar nerve injury to the dorsal branch of the hand.After swelling and nutritional nerve treatment,the function was completely recovered after 3 months.Seven Patients in group A developed symptom of line knot irritation,and there were no skin infections and non-healing wounds in both groups.There was no significant difference in incision length between the two groups(P> 0.05).Although the transosseous tunnel fixation group was significantly larger than the transarticular capsule fixation group in terms of surgical time and intraoperative bleeding(P <0.05),the transosseous tunnel fixation group was significantly better than the transarticular capsule fixation group in Postoperativefixation time(P <0.05).The grip strength and pain of 28 cases were significantly improved compared with those before operation.In group A,the flexion and extension activity of wrist joint was 102.07°±7.26 °,the rotation activity was 131.36°±4.21°,and the ulnar and radial deviation activity was 22.86°±4.72°.134.36°±7.58° 、 149.00°±3.86° 、 41.86°±2.21°,the activity was significantly improved,the difference was statistically significant(P <0.05).Group B Preoperative wrist flexion and extension activity 102.93°±6.65°,rotation activity130.79°±3.93°,ulnar radial deviation activity 22.07°±3.85°,Postoperative 151.21°±3.75°、155.00°±3.98°、36.14°±3.33°,with significant improvement,the difference was statistically significant(P <0.05).There was a clear difference between group A and group B,and the difference was also statistically significant(P <0.05).Modified Mayo wrist function score,group A: excellent in 9 cases,good in 2 cases,fair in 3 cases,excellent and good rate was78.57%,average 81.00±3.70 points,compared with 41.71±4.25 points before surgery,excellent rate was significantly improved,the difference was statistically significant Academic significance(P < 0.05).GrouP B: 11 cases were excellent,2 cases were good,and 1 case was fair.The excellent and good rate was 92.85%,with an average of 92.07±2.84 points,which was significantly higher than the preoperative 41.86±4.97 points.The difference was statistically significant(P <0.05).There was a significant difference between group A and group B,and the difference was also statistically significant(P <0.05).In terms of postoperative imaging evaluation,the distal ulnar radial gap in the posterior anterior wrist radiograph of the wrist joint group was smaller than that of the transarticular capsule fixation group(P <0.05);The average cost of hospitalization was about RMB 5000 less than that of anchor fixation,and the recovery time was about 3 weeks earlier than that of the transarticular capsule fixation group.Conclusion:Wrist arthroscopy is a safe and effective method in the diagnosis and treatment of TFCC injury.The repair of TFCC injury with bone tunnel fixation technology is better than traditional simple debridement and joint capsule repair techniques.This study Provides a new alternative for clinical repair of TFCC IB and ID type injuries. |
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