Current concepts in wrist arthroscopy
Current concepts in wrist arthroscopy
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DOI：
10.1016/j.arthro.2007.10.006
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发表时间：
2008-03-01
影响因子：
4.7
通讯作者：
Poehling, Gary G.
中科院分区：
文献类型：
--
作者：
Chloros, George D.;Wiesler, Ethan R.;Poehling, Gary G.
本文的目的是回顾最近的文献，关节镜治疗桡骨远端骨折（DRF），三角纤维软骨复合体损伤，腕骨间韧带损伤，腱鞘囊肿，包括使用的复位装置。关节镜治疗DRF的一个主要优势是准确评估关节面的状态和检测伴随损伤。关节镜辅助下DRF复位的非随机研究显示了令人满意的结果，但只有1项前瞻性随机研究显示了关节镜与开放复位内固定相比的优势。腕关节镜作为DRF治疗的一部分发挥着重要作用;然而，每位医生和每位患者的治疗需要个性化。腕关节镜是诊断和治疗三角纤维软骨复合体损伤的金标准。1A型损伤可以通过清创术成功治疗，而1B型、1C型和1D型损伤的修复可以获得令人满意的结果。对于2型损伤，关节镜下wafer手术与尺骨短缩截骨术同样有效，但在尺骨正向腕关节中并发症较少。对于骨间韧带损伤，关节镜检查具有重要的诊断价值。清创和固定在急性完全韧带撕裂的设置是有前途的和证明。在慢性患者中，关节镜检查可以根据软骨完整性指导重建选择。腕关节镜手术中使用腕关节镜器械的初步结果令人鼓舞;然而，据报道有并发症，因此，其使用存在争议。对于腕背神经节，关节镜手术与开放性神经节切除术相比，具有良好的效果，复发率较低，且无舟月骨间韧带不稳定发生率。关节镜治疗掌侧腕神经节已经取得了令人鼓舞的初步结果，然而，需要进一步的研究来评估关节镜的安全性和有效性。
The purpose of this article is to review the recent literature on arthroscopic treatment of distal radius fractures (DRFs), triangular fibrocartilage complex injuries, intercarpal ligament injuries, and ganglion cysts, including the use of electrothermal devices. A major advantage of arthroscopy in the treatment of DRFs is the accurate assessment of the status of the articular surfaces and the detection of concomitant injuries. Nonrandornized studies of arthroscopically assisted reduction of DRFs show satisfactory results, but there is only 1 prospective randomized study showing the benefits of arthroscopy compared with open reduction-internal fixation. Wrist arthroscopy plays an important role as part of the treatment for DRFs; however, the treatment for each practitioner and each patient needs to be individualized. Wrist arthroscopy is the gold standard in the diagnosis and treatment of triangular fibrocartilage complex injuries. Type 1A injuries may be successfully treated with debridement, whereas the repair of type 1B, 1C, and 1D injuries gives satisfactory results. For type 2 injuries, the arthroscopic wafer procedure is equally effective as ulnar shortening osteotomy but is associated with fewer complications in the ulnar positive wrist. With interosseous ligament injuries, arthroscopic visualization provides critical diagnostic value. Debridement and pinning in the acute setting of complete ligament tears are promising and proven. In the chronic patient, arthroscopy can guide reconstructive options based on cartilage integrity. The preliminary results of wrist arthroscopy using electrothermal devices are encouraging; however, complications have been reported, and therefore, their use is controversial. In dorsal wrist ganglia, arthroscopy has shown excellent results, a lower rate of recurrence, and no incidence of scapholunate interosseous ligament instability compared with open ganglionectomy. Arthroscopy in the treatment of volar wrist ganglia has yielded encouraging preliminary results; however, further studies are warranted to evaluate the safety and efficacy of arthroscopy.