关节镜下治疗腕三角软骨损伤__培训课件.pptVIP

Pearls Patients with injuries to the wrist, particularly displaced distal radius fractures, should be examined after reduction for instability of the DRUJ. The majority of patients presenting with ulnar sided wrist pain can be managed non-operatively and returned to normal activities. The central component of the TFCC can be excised to a stable rim without compromising its biomechanical function. * Pitfalls The differential diagnosis of ulnar sided wrist pain is lengthy. A careful examination of the ulnar side of the wrist will frequently rule in others causes of patients’ symptoms. The dorsal branch of the ulnar nerve crosses from volar to dorsal in the region of ulnar (6U) wrist arthroscopy portals. Careful dissection and protection of this nerve is mandatory to prevent complications. * Step by step a large central tear (arrow) along the radial aspect of the articular disc of the TFCC. Associated subchondral degenerative changes are evident within the proximal lunate * * A typical degenerative central tear a discrete vertical tear (arrow) involving the thicker, volar radioulnar ligament component of the TFCC. * * avulsion of the ulnar styloid attachment of the TFC * TFCC tears were classified according to its location as 1 if it was at the cartilage attachment to the radius; 2, pararadial (2–3 mm from the radius); 3, at the mid portion; 4, paraulnar (2–3 mm from the ulnar insertion point of the TFC); or 5, at the ulnar insertion point(Fig 4) * location of the TFCC tears * a relatively big communicating tear (arrow head) close to the radial attachment of the TFCC with more fat sat sequences as required * A small central perforation (arrow) is seen within the central portion of the articular disc of the triangular fibrocartilage complex. An additional, partial thickness undersurface tear (arrowhead) is also present at the articular disc. Arthroscopic inspection Conservative Activity avoidance Steroid injection (10mg Kenolog) Surgery Treatment Arthroscopic Repair