삼각섬유연골 복합체 척골와 파열의 수술 기법: 관절경을 통한 비매듭성 봉합술

김재광,김재광 대한수부외과학회 2014 대한수부외과학회지 Vol.19 No.2

Knotless repair of triangular fibrocartilage complex has several advantages. All procedures for triangular fibrocartilage complex repair could be done under arthroscopy in this technique. In addition, this technique allows for repair of deep layers of triangular fibrocartilage complex down to fovea of the ulnar head. This article describes arthroscopic repair of the Palmer type 1B triangular fibro- cartilage complex tear using arthroscopic knotless technique. 비매듭성 봉합은 삼각섬유연골 복합체 파열의 치료에 몇 가지 장점이 있는데, 봉합을 위한 모든 과정을 관절경하에서시행하는 것이 가능하고 삼각섬유연골 복합체의 심부 파열 시 척골와에 직접 봉합하는 것이 가능하다. 본 논문은 삼각섬유연골 복합체가 Palmer type 1B의 형태로 척골와에서 파열 시 비매듭성 봉합 나사못을 이용한 수술적 봉합 방법에대해 기술하고자 한다.

삼각섬유연골 복합체에 발생한 결절종 - 1예 보고 -

이상선,박종석,박성용,김준범 대한수부외과학회 2011 대한수부외과학회지 Vol.16 No.1

결절종은 수부와 완관절에서 흔한 연부 조직 양성 종물로 전형적으로 요수근 관절의 배부에 생기면서 통증을 유발하기도 한다. 저자들은 삼각섬유연골 복합체에 발생한 결절종을 관절경을 이용하여 수술적 치료를 경험하였기에 보고하고자 한다. Ganglions are the most common mass occurred in the wrist and hand. Ganglion usually arises from the dorsal aspect of the radiocarpal joint that may lead to the wrist pain. We report a patient with a ganglion of the triangular fibrocartilage complex. Using arthroscopic technique, ganglion located in triangular fibrocartilage complex was successfully excised.

삼각 섬유연골 복합체 부분 파열에 대한 관절강내 봉약침 시술 치험 1례

이광호,유영진,선승호,권기록,Lee, Kwang-Ho,Ryu, Young-Jin,Sun, Seung-Ho,Kwon, Ki-Rok 대한약침학회 2009 Journal of pharmacopuncture Vol.12 No.4

Objective: This case was to report a case of Partial Tear of Triangular Fibrocartilage Complex treated by Intra-articular bee venom Pharmacopuncture. Methods: The patient was treated by Intra-articular bee venom Pharmacopuncture. The Effect of Treatment was evaluated by Visual Analog Scale(VAS) and Modified Mayo Wrist Score(Wrist Score). Results & Conclusions: After Treatment, Patient's VAS decreased and Wrist Score increased. For this results, Intra-articular Bee Venom Pharmacopuncture may be effective for Partial Tear of Triangular Fibrocartilage Complex.

삼각섬유연골 복합체 스포츠 손상에 대한 한방 복합 침치료 시술 치험 1례

전세환(Se Hwan Jeon),조용규(Yong Kyu Cho),강병구(Byeong Gu Gang),고원일(Won Il Koh),이근재(Keun Jae Lee),윤영석(Young Suk Yoon) 대한스포츠한의학회 2018 대한스포츠한의학회지 Vol.18 No.1

Objective This case was to report a case of sports injury of Triangular Fibrocartilage Complex(TFCC) by combined acupuncture treatment. Methods The Patient was treated by combined acupuncture treatment consisted of acupuncture, pharmacopuncture, electroacupuncture, in-frared irradiation therapy. Treatment was evaluated by Numeric Rating Scale(NRS). Results & Conclusions After Treatment, Patient s NRS decreased and Patient can do sports activity like before injury. Combined acupuncture treatment may be effective for sports injury of TFCC.

삼각섬유연골 복합체 척골두 와 부착부 파열의 수술 방법: 관절경적 척골관통 봉합술

박종웅 대한수부외과학회 2014 대한수부외과학회지 Vol.19 No.2

As the importance of the foveal attachment of the triangular fibrocartilage com- plex (TFCC) on the stability of the distal radioulnar joint (DRUJ) is emphasized, the traditional repair techniques such as arthroscopic capsular repair for the 1B TFCC tear become accepted as ineffective method for treating DRUJ instability. Recently, several techniques which repair the TFCC directly to the ulnar fovea have been developed and introduced. Further advances of the techniques will be expected with increasing knowledge of the anatomy and biomechanics of the TFCC and DRUJ. Regardless of the techniques, fundamental principle of anatomical repair of the TFCC to the ulnar fovea is utmost important. Herein we present our technique of arthroscopic transosseous repair by making a drill hole in the ulnar and securing the sutures with Pushlock anchors. 최근 삼각섬유연골 복합체(triangular fibrocartilage complex, TFCC)의 해부학 및 원위 요척관절의 불안정성에 관여하는 근위 TFCC의 척골두 와 부착부의 중요성이 강조되면서 원위 요척관절의 불안정을 동반한 TFCC 파열의 수술적 치료 시 과거와 같이 경상돌기 부착부, 즉 윈위 TFCC 파열만 관절막에 봉합하는 방법은 더 이상 원위 요척관절의안정성을 회복하기 어려운 것으로 인정되고 있다. 원위 요척관절의 불안정을 동반한 Palmer 1B의 근위 TFCC 파열의수술 방법은 과거 여러 가지 수술 방법이 소개된 바 있고 각 수술법을 행함에 있어서도 술자마다 다양한 변형된 수술 방법을 구사할 수 있다. 향후 TFCC의 기능과 해부학, 원위 요척관절의 생역학에 대한 심층적 연구와 함께 다양한 수술방법의 진화가 기대된다. 하지만 어떤 방법을 사용하든 수술의 가장 중요한 목표는 파열된 부분을 원래 해부학적 위치인 척골두 와에 정확히 부착시킴으로써 파열전의 상태와 가장 가깝게 치유되게 하는 것임에는 이견이 없을 것이다. 본종설에서는 관절경하에서 척골을 통과하여 척골두 와의 등척부에 골관통 구멍을 만든 후 근위 TFCC의 척골두 와 부착부위를 봉합하는 관절경적 골관통 봉합법(arthroscopic transosseous suture repair)을 소개하고자 한다.

비매듭 봉합 나사못을 이용한 삼각섬유연골 복합체 1B형 파열의 All-inside 관절경하 봉합술의 단기 추시 결과

박용철,서창영,김명선,김종석,심상규,이진호 대한수부외과학회 2013 대한수부외과학회지 Vol.18 No.2

목적: 비 매듭 봉합 나사못을 이용한 Palmer 분류 1B형 삼각섬유연골 복합체 파열의 관절경하 봉합술의 단기 추시 결과를 알아보고자 하였다. 방법: 관절경하 삼각섬유연골 복합체 봉합술을 시행하고 3개월 이상 추시가 가능하였던 23명을 대상으로 하였다. 평균추시 기간은 6.6개월(범위, 3-10개월)이었으며 평균 연령은 36.3세(범위, 16-48세)였다. 증상 발현부터 내원까지 기간은평균 10.9개월(범위, 1주-7년)이었다. 관절경 소견상 Palmer 1B형 15예, 1B 및 1D형 2예, 1B 및 2C형은 6예였으며, 모두 hook test 양성이었다. 동반 병변은 주상-월상 인대 손상 16예(69.6%), 월상-삼각 인대 손상 10예(43.5%), 척골 경상돌기 불유합 2예, 척측 결절종이 2예 존재하였다. 삼각섬유연골 복합체 파열에 대해 관절경하 비매듭 봉합 나사못을 이용한 봉합을 시행하였고, 2예의 1D 파열에 대해 부분 절제술을, 6예의 2C 병변에 대해서는 원위 척골 부분 절제술을 시행하였다. 주상-월상 인대 손상 16예 가운데 Geissler 분류상 3도가 7예, 2도가 9예였으며, 3도 손상은 관절경하 봉합을 6예 시행하였고, 2도 손상은 4예에서 관절경하 봉합술을 시행하였다. 결과: Mayo modified wrist score로 평가하였다. 우수 4예, 양호 14예, 보통 5예로 18예(78.3%)에서 양호 이상의 결과를 보였다. 19예(82.6%)에서 직장이나 취미 생활로 복귀가 가능하였다. 결론: Palmer 분류 1B형의 삼각섬유연골 복합체 손상에 대한 비매듭 봉합 나사못을 이용한 관절경하 봉합술은 비교적좋은 결과를 얻을 수 있는 술기이며, 동반 손상에 대한 적절한 조치가 필요할 것으로 생각된다. Purpose: We studied the short term results of the arthroscopic repair of 1B type triangular fibrocartilage complex (TFCC) tear using a knotless suture anchor. Methods: We evaluated 23 patients who underwent all-inside arthroscopic TFCC repair using a knotless suture anchor. The average follow-up duration was 6.6 months (range, 3-10 months). Mean duration of symptom was 10.9months (range, 1 week-7 years). The arthroscopic finding documented 15 type 1B, 2 1B with 1D, and 6 1B with 2C lesions. All showed the positive hook test. The concomitant pathologies were 16 scapholunate injuries and 10 lunotriquetral injuries. TFCC tears were repaired by the knotless suture anchor. The Wafer procedure was done for 2C lesions. Results: According to Mayo modified wrist score, the result was excellent in 4,good in 14 and fair in 5. Nineteen patients (82.6%) could return to his job or hobby. Conclusion: The all-inside arthroscopic repair using knotless suture anchor for TFCC 1B tear can provide good results. The appropriate management should be done for the concomitant pathologies for the better results.

야구선수 손목관절의 삼각 섬유연골 복합체 손상에 대한 고찰

박승규,김영록,안연준 대불대학교 2003 大佛大學校大學院 硏究論文集 Vol.2 No.1

The Triangular Fibrocartilage Complex(TFCC) is an anatomic structure that is located on the ulnar side of the wrist. It is composed of cartilage and ligament and serves as a stabilizing cushion between the distal ulnar and the carpus. Disorders of the TFCC are a common source of pain on the ulnar side of the wrist. It is known that injuries of the TFCC can result in prolonged disability and impaired function of the and wrist. The importance to understand the wrist lesion in baseball player is that many of these lesions seen mild at the onset and can often be easily managed, but permanent disability can result from the delayed or inadquate treatment. So, I found the 5 cases of TFCC injury in baseball player and have performed radiological study and Magnetic Resonance Imaging(MRI).

외상성 삼각섬유연골 복합체 손상과 원위부 요척 관절의 불안정성

김병성(Byungsung Kim),노재휘(Jae-Hwi Nho),정기진(Ki Jin Jung),윤건희(Keonhee Yun),김영환(Young Hwan Kim),윤홍기(Hong-Kee Yoon) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.2

삼각섬유연골 복합체(triangular fibrocartilage complex, TFCC) 외상성 병변은 원위부 요척 관절(distal radioulnar joint, DRUJ)의 불안정을 유발할 수 있어 파열의 위치와 정도에 따라 적절한 치료방법을 설정하는 것이 중요하다. TFCC의 손상은 DRUJ 불안정성을 유발할 수 있는 불안정형 병변과 DRUJ 불안정을 유발하지 않는 안정형 병변으로 구분된다. 병변의 위치와 손상 정도에 따라 관절경적 변연절제술, 관절경적 봉합술 등이 고려될 수 있다. DRUJ 불안정을 유발할 수 있는 척측부 견열 손상의 경우는 관절경적인 변연절제술 후 손상이 있는 부위를 정확히 확인한 다음 suture anchor를 이용한 고정이나 끌어내기 봉합이 유용하다. 척측 견열 손상에 대한 TFCC의 봉합술은 다양한 방법과 술기가 보고되어 손상 위치 및 정도에 따라 적절한 선택이 필수적이다. 척골 양성변이와 동반된 TFCC 파열 역시 파열의 위치와 DRUJ의 불안정성 여부에 따라 수술 방법을 결정하게 되고, DRUJ 불안정성을 해결하기 위해서는 TFCC의 봉합이 중요하며, 경우에 따라 척골단축술을 고려할 수 있다. 단 TFCC 변연부 심부 파열인 경우 척골충돌증후군과 DRUJ 불안정성이 동반되어 있을 때에는 척골단축술만으로는 DRUJ 불안정성을 해결할 수 없기 때문에 척골단축술과 TFCC 봉합을 동시에 시행을 할 수 있다. Traumatic triangular fibrocartilage complex (TFCC) injuries require multidisciplinary approach and plan. Trauma to TFCC can lead to instability of the distal radioulnar joint (DRUJ). Injury to TFCC is classified as a stable type that does not cause unstable lesions for DRUJ or unstable type that can cause instability of DRUJ. According to the location and severity of the injury, arthroscopic debridement or arthroscopic repair may be considered. In the ulnar side avulsion of TFCC, which could cause DRUJ instability, arthroscopic examination should be performed to identify an accurate location of the damaged structures, followed by arthroscopic debridement and repair. In the event of TFCC and DRUJ injuries with ulnar positive variance, arthroscopic TFCC repair or ulnar shortening osteotomy after arthroscopic debridement could be considered to solve the instability and ulnar side pain. However, if peripheral TFCC tear with ulnar impaction syndrome and DRUJ instability, it combined operation of ulnar shortening osteotomy and TFCC foveal fixation could be considered. An accurate classification of TFCC and DRUJ injuries is necessary. It is important to resolve and prevent recurrence of ulnar wrist pain caused by instability.

A Comparative Study between Conservative and Surgical Treatments of Triangular Fibrocartilage Complex Injury of the Wrist with Distal Radius Fractures

Jemin Im,Sung Jin Kang,이승준 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.1

Background: Triangular fibrocartilage complex (TFCC) injury is common in distal radius fractures. The purpose of this study was to compare the conservative and surgical treatments of TFCC injury of the wrist associated with distal radius fractures. Methods: A retrospective study was conducted on 39 patients who received treatment for TFCC injury with distal radius fractures. All patients were treated using a volar locking plate for distal radius fractures. Twenty-six patients who received conservative treatment for TFCC through long arm splinting were classified into group 1, and 13 patients who received surgical treatment for TFCC were classified into group 2. The splint was maintained for 6 weeks in both groups. For clinical evaluation, the range of motion (ROM) of the wrist joint, patient-rated wrist evaluation (PRWE) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, and grip strength were measured. Distal radioulnar joint (DRUJ) stability was evaluated through a stress load test and graded between grade 0 and 3 intraoperatively after fixation and at the final follow-up. Results: In group 1, the average DASH score was 11.1 ± 4.4, the average PRWE score was 10.2 ± 4.6, the grip strength was 89.4% relative to the unaffected side, the average ROM of the wrist joint was 65° ± 7.0° for extension, 51.5° ± 8.1° for flexion, 86° ± 5.1° for supination, and 85° ± 5.2° for pronation, and DRUJ stability at the final follow-up was grade 0 in 58.62%, grade 1 in 31.03%, grade 2 in 10.34%, and grade 3 in 0%. In group 2, the average DASH score was 13 ± 5.0, the average PRWE score was 12.4 ± 3.7, the grip strength was 87.3% relative to the unaffected side, and the average ROM of the wrist joint was 60° ± 9.8° for extension, 53.1° ± 7.0° for flexion, 85° ± 5.3° for supination, and 86.8° ± 4.5° for pronation. At the final follow-up, DRUJ stability was grade 0 in 66.67%, grade 1 in 25%, grade 2 in 8.3%, and grade 3 in 0%. The 2 groups showed no statistically significant differences in DASH score, PREW score, grip strength, ROM, and final follow-up DRUJ stability. Conclusions: There were no statistically significant differences in the clinical outcomes between the surgical and conservative treatment groups. Therefore, when normal radiological indices are achieved after treatment of distal radius fractures, DRUJ stability can be obtained by conservative treatment.

Efficacy of Integrated Korean Medicines in the Treatment of Partial Triangular Fibrocartilage Complex Tears: A Case Report

Ha Jae-Joon,Yang Myeong-yeol,Kim Ji-Sun,Choi Hong-Wook,Lee Gyu-Bin,Yoon Dong-Ju,Kim Dong-Jin,Kim Do-Young 대한침구의학회 2023 대한침구의학회지 Vol.40 No.4

The triangular fibrocartilage complex (TFCC) is crucial for stabilizing the ulnar side of the wrist but can be partially torn due to degenerative changes, falling, or sudden injuries. However, only a few studies have focused on the use of Korean medicine treatments for TFCC-related wrist pain. This case report presents the successful outcomes of integrated Korean medicine treatment in a patient with a partial TFCC tear. The diagnosis was confirmed via magnetic resonance imaging, which revealed the tear. Subsequently, the patient received integrated Korean medicine treatments. The assessment of the pain scale scores revealed a significant reduction in wrist pain and an improvement in daily life activities. Based on the findings of this study, integrated Korean medicine treatments have been proven to be an effective treatment option for patients with a partial TFCC tear. However, further research is needed to determine the potential benefits and mechanisms of these treatments in managing TFCC-related wrist pain.