手関節鏡手術の現状と展望

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  • Current Status and Future of Wrist Arthroscopy
  • シュカンセツキョウ シュジュツ ノ ゲンジョウ ト テンボウ

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Wrist arthroscopy, first reported by Chen in 1979, has become a valuable procedure for hand surgeons in both diagnostic and therapeutic modalities. In recent years, arthroscopy has been successfully used with many modifications and improvements. The advent of various new portals allows the wrist joint to be viewed from any perspective. Arthroscopic assessment of distal radius fracture is mandatory because intraarticular fracture reduction is superior to that obtained with fluoroscopy, with the advantage of also being able to investigate associated soft-tissue injuries. However, volar locking plate fixation has become popular, and during this procedure arthroscopic procedures become problematic because vertical traction has to be both applied and released during surgery. We developed a plate presetting arthroscopic reduction technique to simplify the combination of plating and arthroscopy. The triangular fibrocartilage complex (TFCC) tear is a major injury that can be better managed arthroscopically. Palmer’s classification for TFCC injury is globally used; however, it has been noted that this classification is inconsistent with current anatomical investigations. Hence, we proposed a new classification including atypical tears such as dorsal tears and foveal tears.<br>Indications for wrist arthroscopy have continued to expand to scaphoid nonunion, scapholunate ligament reconstruction, distal radioulnar ligament reconstruction, arthrodesis, and some carpectomies. Complications of wrist arthroscopy are relatively uncommon. With the ever-expanding list of indications and procedures that can be performed with wrist arthroscopy, it will become an essential diagnostic and therapeutic procedure for the hand surgeon.

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