Management of Ulnar Wrist Pain Without Ulnar Plus Variance: A Comparative Study of Arthroscopic Triangular Fibrocartilage Complex Repair and Ulnar Shortening Osteotomy.

IF 0.5 Q4 SURGERY
Katsuhiro Tokutake, Masahiro Tatebe, Katsuyuki Iwatsuki, Hidemasa Yoneda, Keiichiro Nishikawa, Michiro Yamamoto
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Abstract

Background: Managing ulnar wrist pain without ulnar plus variance presents a clinical challenge. This study aimed to compare the causes of symptom onset and surgical outcomes between arthroscopic triangular fibrocartilage complex (TFCC) repair and ulnar shortening osteotomy (USO) and analyse factors influencing pain reduction following arthroscopic TFCC repair. Methods: Twenty-four patients without ulnar plus variance who underwent either arthroscopic TFCC repair or USO at our institution were retrospectively reviewed. Demographic data, symptom onset causes, time from onset to surgery, pre- and postoperative range of motion (ROM), grip strength ratio (injured to uninjured wrist), numeric pain rating scale (NRS), change in NRS and Hand20 scores were compared between the two treatment groups. For TFCC repair, correlations were investigated between NRS change and time from onset to surgery and between NRS change and age. Results: Of 24 patients, 14 underwent arthroscopic TFCC repair and 10 underwent USO. Only two patients in the USO group had no clear onset trigger, whereas most had identifiable triggers. Both groups showed no significant differences in pre- and postoperative ROM, grip strength ratio, NRS and Hand20 score. The change in NRS was significantly greater in the USO group (p = 0.049). For the TFCC repair group, NRS change was significantly negatively correlated with age (Spearman's rank correlation coefficient -0.603, p = 0.029). Conclusions: Our findings indicate that patients without ulnar plus variance who experience symptom onset including trauma often have an underlying degenerative component as well as instability. USO provides significant pain relief in such cases. Arthroscopic TFCC repair was effective in young patients in whom instability was the primary cause of pain and age was associated with pain reduction rather than time from onset to surgery. Effective treatment strategies for ulnar wrist pain without ulnar plus variance should consider both age and wrist arthroscopy findings to optimise outcomes. Level of Evidence: Level IV (Therapeutic).

无尺侧变异的尺腕部疼痛的治疗:关节镜下三角纤维软骨复合体修复与尺侧缩短截骨术的比较研究。
背景:处理无尺骨变异的尺腕部疼痛是一个临床挑战。本研究旨在比较关节镜下三角纤维软骨复合体(TFCC)修复和尺骨缩短截骨术(USO)的症状发生原因和手术结果,并分析影响关节镜下TFCC修复后疼痛减轻的因素。方法:回顾性分析我院24例接受关节镜TFCC修复或USO治疗的无尺侧变异患者。比较两组患者的人口学资料、症状发生原因、发病至手术时间、术前和术后活动度(ROM)、握力比(受伤腕与未受伤腕)、数字疼痛评定量表(NRS)、NRS和Hand20评分的变化。对于TFCC修复,研究了NRS变化与发病至手术时间以及NRS变化与年龄之间的相关性。结果:24例患者中,14例行关节镜TFCC修复术,10例行USO。USO组中只有两名患者没有明确的发病诱因,而大多数患者都有可识别的诱因。两组术前、术后ROM、握力比、NRS、Hand20评分差异无统计学意义。USO组NRS变化明显大于USO组(p = 0.049)。TFCC修复组NRS变化与年龄呈显著负相关(Spearman’s秩相关系数-0.603,p = 0.029)。结论:我们的研究结果表明,没有尺侧变异的患者经历包括创伤在内的症状发作,通常有潜在的退行性成分和不稳定性。USO在这种情况下提供了显著的疼痛缓解。关节镜下TFCC修复对年轻患者有效,其中不稳定是疼痛的主要原因,年龄与疼痛减轻有关,而不是从发病到手术的时间。无尺骨变异的尺腕部疼痛的有效治疗策略应考虑年龄和关节镜检查结果,以优化结果。证据等级:IV级(治疗性)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.90
自引率
0.00%
发文量
304
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