腕关节镜在腕部疼痛中的作用
主诉腕部疼痛的患者通常描述疼痛干扰其日常活动、工作或运动。部分患者可能报告有特定的腕部损伤史，最常见的损伤机制是手部伸展着地摔倒。他们通常会被建议先尝试保守治疗，包括非甾体抗炎药物、类固醇注射、休息和夹板固定，初期平均持续3-6个月。检查包括X光和磁共振成像（MRI）。
当初期治疗失败时，我们通常会在全身或区域麻醉下进行腕关节镜检查。腕关节镜自20世纪70年代作为一种新描述的技术发展至今，已成为每位治疗各种腕部疾病的医生武器库中不可或缺的诊断和治疗工具。它有助于明确软组织损伤的模式、组合和范围，这些损伤往往比临床怀疑的更广泛。对于保守治疗无效的慢性腕部疼痛患者，通过腕关节镜检查，我们发现许多患者同时存在腕骨间韧带（舟月韧带和月三角韧带）损伤以及三角纤维软骨复合体（TFCC）损伤。其他发现包括滑膜炎和软骨病变，如月骨软骨软化。发现双重或三重病变并不罕见。
许多手术可以通过关节镜进行，如滑膜切除术、射频消融、软骨缺损清创、外周TFCC撕裂修复，甚至有限融合。术后腕部用支具或夹板固定6周，并开始职业治疗，进行关节活动度和握力强化练习。
腕关节镜在治疗慢性腕部疼痛中具有重要价值。它允许直接观察腕关节，从而识别腕部多处部分损伤，如韧带松弛和软骨软化，这些在其他影像学检查中不易发现。许多外科医生将其视为诊断腕部不稳定的金标准检查，尤其是因为它能检测固有韧带的孤立撕裂并显示退行性关节变化。腕关节镜还允许在干预过程中治疗病变。其缺点包括手术风险、需要区域或全身麻醉以及费用。
关节镜的主要局限性在于，并非所有通过关节镜发现的异常都一定是病理性的或导致患者症状的原因。治疗结果的评估也很困难，因为对并存损伤的治疗可能是症状改变的原因。然而，许多研究已证明腕关节镜是安全、可靠的，对预后有积极影响，尤其是在缓解腕部疼痛方面。When initial management fails, we usually proceed to perform wrist arthroscopy under general or regional anesthesia. Wrist arthroscopy has progressed from a newly described technique since the 1970s to become an essential diagnostic and therapeutic tool in the armamentarium of every surgeon treating various wrist disorders. It is useful in defining the patterns, combinations and extent of soft tissue injuries which are often more extensive than clinically suspected. In treating patients with chronic wrist pain recalcitrant to conservative treatment with wrist arthroscopy, we found many patients having concomitant intercarpal ligament (scapholunate & lunotriquetral ligament) injuries as well as triangular fibrocartilage complex (TFCC) injuries. Other findings included synovitis and chondral lesions such as lunate chondromalacia. It is not uncommon to find double or triple pathologies.
Many procedures can be performed arthroscopically such as synovectomy, radiofrequency ablation, debridement of any chondral defects, repair of peripheral TFCC tears and even limited fusion. Postoperatively the wrist was placed in a brace or splint for 6 weeks and started on occupational therapy for range of motion and grip-strengthening exercises.
Wrist arthroscopy has a valuable role in the treatment of chronic wrist pain. It allows direct visualization of the wrist joint and therefore identification of multiple partial injuries in the wrist, such as ligament attenuations and chondromalacia, not readily apparent on other imaging modalities. Many surgeons regard it as the gold standard investigation in the diagnosis of carpal instability, especially as it can detect isolated tears of intrinsic ligaments and demonstrate degenerative joint changes. Wrist arthroscopy also enables one to treat the pathology during the intervention. Its disadvantages are the surgical risks, the need for regional or general anesthesia as well as its costs.
The main limitation of arthroscopy is that not all abnormalities identified by arthroscopy are necessarily pathologic or responsible for the patient’s symptoms. Evaluation of the results of treatment is also difficult because treatment of coexistent injuries may be responsible for the alteration of symptoms. However, many studies have proven wrist arthroscopy to be a safe, reliable with a favorable impact upon the outcomes, especially in relieving wrist pain.
