關(guān)節(jié)鏡下治療腕三角軟骨損傷

（優(yōu)選）關(guān)節(jié)鏡下治療腕三角軟骨損傷當前第1頁\共有64頁\編于星期五\2點Anatomy當前第2頁\共有64頁\編于星期五\2點TFCC當前第3頁\共有64頁\編于星期五\2點TFCCTriangularfibrocartilage(articulardisc)MeniscushomologueUCL(ulnarcapsule)VolarandDorsalDRULigamentsECUsubsheathPrestyloidrecess當前第4頁\共有64頁\編于星期五\2點當前第5頁\共有64頁\編于星期五\2點2023/6/1A3DdepictionoftheTFCC當前第6頁\共有64頁\編于星期五\2點Arthroscopy當前第7頁\共有64頁\編于星期五\2點當前第8頁\共有64頁\編于星期五\2點ComplexfibrousstructureonvolaraspectofwristOrigin-dorsaldistalcornerofsigmoidnotchInsertion-triquetrumandbaseoffifthmetatarsalPartiallyorcompletelyseparatespisotriquetraljointfromradiocarpaljointMENISCUSHOMOLOGUE當前第9頁\共有64頁\編于星期五\2點ULNOLUNATEANDULNOTRIQUETRALLIGAMENTSFromvolaraspectofradioulnarligamenttolunateandTriquetrumFirmlyattachedtotriquetrumLessstrongattachmenttolunate當前第10頁\共有64頁\編于星期五\2點ULNOLUNATEANDULNOTRIQUETRALLIGAMENTSFromvolaraspectofradioulnarligamenttolunateandtriquetrum當前第11頁\共有64頁\編于星期五\2點Type1-TraumaticAHorizontaltearadjacenttotheradiusBPeripheraldetachmentfromtheulnaCTearoftheUlnocarpalligamentsDAvulsionfromsigmoidnotchPALMERCLASSIFICATION當前第12頁\共有64頁\編于星期五\2點TypeII-DegenerativeAPartialthicknessthinningofthearticulardiscBA+Chondromalaciaoflunateand/orulnarheadCB+fullthicknesstearofthearticulardiscDC+PartialtearofthelunatotriquetralligamentED+FulltearofthelunatotriquetralligamentandarthrosisPALMERCLASSIFICATION當前第13頁\共有64頁\編于星期五\2點TFCCTRAUMATICTEAR當前第14頁\共有64頁\編于星期五\2點2023/6/1Anatomy當前第15頁\共有64頁\編于星期五\2點2023/6/1TheulnarportionoftheTFCCisvascularisedbyulnarandposteriorinterosseousartery

brachesThecentralandradialaspectsofthecomplexareavascularVascularsupply當前第16頁\共有64頁\編于星期五\2點TransmitloadStablisetheDRUJbiomechanicalfunctions當前第17頁\共有64頁\編于星期五\2點biomechanicalfunctions2023/6/11)stabilityofthedistalradioulnarjoint(DRUJ),2)axialloadtransmissionfromthecarpustotheulnaand3)ulnarsidedcarpalstability.當前第18頁\共有64頁\編于星期五\2點NaturalHistory<20yearsnoTFCperforations>60years50%hadTFCperforationsFallondorsiflexedandulnardeviated

wristAxialloadwithforearminhyperpronation當前第19頁\共有64頁\編于星期五\2點SymptomsUlnarsidedwristpainQuitewelllocalisedUsuallywithulnardeviationSuddenpronationactivityClickingonrotationInstabilityisrare當前第20頁\共有64頁\編于星期五\2點SignsPronationUlnardevationAxiallyloadRotate當前第21頁\共有64頁\編于星期五\2點InvestigationsX-rayMRIArthroscopySonographArthroscopy--------goldstandard當前第22頁\共有64頁\編于星期五\2點2023/6/1Usingarthroscopyasthegoldstandard,MRIhasbeenshowntohaveanaccuracyof64–

75%forperforationsortears.1TheinhomogeneoussignalintensityandstriatedappearanceoftheTFCCespeciallytheulnarsidemaymakethesedisruptionsmore

difficulttodetectPSMcAlinden,JTeh,.Imagingofthewrist.Imaging2003;15:180-192MariusRSchmid,ThomasSchertler,ChristianWPfirrmann,NadjaSaupe,MirjanaManestar,SimonWildermuthetal.Interosseousligamenttearsofthewrist:comparisonofmulti-detectorrowCTarthrographyandMRimaging.Radiology2005;237:1008-1013當前第23頁\共有64頁\編于星期五\2點TFCCTearPathoanatomyTearinstructuresofTFCCPositiveulnarvariancepredisposestoinjury當前第24頁\共有64頁\編于星期五\2點2023/6/1arthrogramatearatthepararadialpartoftheTFCC(site2)B:coronalT1WFatSatsequenceconfirmingthearthrogramfindingandclearlyshowthetear(arrow).當前第25頁\共有64頁\編于星期五\2點About60-70%oftheTFCCtearsareassociatedwithulnarstyloidfractureJLJLHobby,BDBDTom,PWPWBearcroft,AKAKDixon.Magneticresonanceimagingofthewrist:diagnosticperformancestatistics.ClinRadiol2001;56:50-57當前第26頁\共有64頁\編于星期五\2點ultra-high-frequencysonograph當前第27頁\共有64頁\編于星期五\2點2023/6/1TheTFCCappearsverysimilartothekneemeniscusonMRIimagesOnesonSR,TiminsME,ScalesLM,EricksonSJ,ChamoyL.MRimagingdiagnosisoftriangularfibrocartilagepathologywitharthroscopiccorrelation.AJRAmJRoentgenol1997;168:1513-1518.當前第28頁\共有64頁\編于星期五\2點TFCCTRAUMATICTEAR當前第29頁\共有64頁\編于星期五\2點TFCCTearImagingPlainfilmsmayshowpositiveulnarvarianceAssessforfractureorulnarsubluxationMRIorArthrography當前第30頁\共有64頁\編于星期五\2點alargecentraltear(arrow)alongtheradialaspectofthearticulardiscoftheTFCC.Associatedsubchondraldegenerativechangesareevidentwithintheproximallunate2023/6/1當前第31頁\共有64頁\編于星期五\2點2023/6/1Atypicaldegenerativecentraltear當前第32頁\共有64頁\編于星期五\2點adiscreteverticaltear(arrow)involvingthethicker,volarradioulnarligamentcomponentoftheTFCC.2023/6/1當前第33頁\共有64頁\編于星期五\2點2023/6/1avulsionoftheulnarstyloidattachmentoftheTFC當前第34頁\共有64頁\編于星期五\2點2023/6/1TFCCtearswereclassifiedaccordingtoitslocationas1ifitwasatthecartilageattachmenttotheradius;2,pararadial(2–3mmfromtheradius);3,atthemidportion;4,paraulnar(2–3mmfromtheulnarinsertionpointoftheTFC);or5,attheulnarinsertionpoint(Fig4)當前第35頁\共有64頁\編于星期五\2點2023/6/1locationoftheTFCCtears當前第36頁\共有64頁\編于星期五\2點2023/6/1arelativelybigcommunicatingtear(arrowhead)closetotheradialattachmentoftheTFCCwithmorefatsatsequencesasrequired當前第37頁\共有64頁\編于星期五\2點2023/6/1Asmallcentralperforation(arrow)isseenwithinthecentralportionofthearticulardiscofthetriangularfibrocartilagecomplex.Anadditional,partialthicknessundersurfacetear(arrowhead)isalsopresentatthearticulardisc.當前第38頁\共有64頁\編于星期五\2點當前第39頁\共有64頁\編于星期五\2點當前第40頁\共有64頁\編于星期五\2點當前第41頁\共有64頁\編于星期五\2點當前第42頁\共有64頁\編于星期五\2點當前第43頁\共有64頁\編于星期五\2點當前第44頁\共有64頁\編于星期五\2點當前第45頁\共有64頁\編于星期五\2點當前第46頁\共有64頁\編于星期五\2點當前第47頁\共有64頁\編于星期五\2點當前第48頁\共有64頁\編于星期五\2點當前第49頁\共有64頁\編于星期五\2點Arthroscopicinspection當前第50頁\共有64頁\編于星期五\2點ConservativeActivityavoidanceSteroidinjection(10mgKenolog)SurgeryTreatment當前第51頁\共有64頁\編于星期五\2點ArthroscopicRepairDebridementShaversRadiofrequency(Vapr)–keeptheheatdownOpenRepairUlnarShorteningSurgery當前第52頁\共有64頁\編于星期五\2點當前第53頁\共有64頁\編于星期五\2點當前第54頁\共有64頁\編于星期五\2點當前第55頁\共有64頁\編于星期五\2點當前第56頁\共有64頁\編于星期五\2點當前第57頁\共有64頁\編于星期五\2點當前第58頁\共有64頁\編于星期五\2點2023/6/1TheperipheralandcentraltearsoftheTFCCmustbedifferentiatedasthemodeof

treatmentisdifferentbetweenthetwoconditions,peripheraltearshaveagoodvascularsupplyandarerepairedhowevercentraltearsareavascularandarecommonly

managedwithdebridement.MarcoZanetti,DavidLinkous,LouisA.Gilula,JuergHodler,.CharacteristicsofTriangularFibrocartilageDefectsinSymptomaticandContralateralAsymptomaticWrists.Radiology2000;216:840-845.當前第59頁\共有64頁\編于星期五\2點Arthroscopictreatment2023/6/1當前第60頁\共有64頁\編于星期五\2點Case1,suture當前第61頁\共有64頁\編于星期五\2點Case2,debridement當前第62頁\共有64頁\編于星期五\2點PearlsPatientswithinjuriestothewrist,particularlydisplaceddistalra