Weinstein Loryn P, Berger Richard A
Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
J Hand Surg Am. 2002 Sep;27(5):833-9. doi: 10.1053/jhsu.2002.35302.
Partial wrist denervation is a useful palliative procedure for chronic wrist pain when reconstructive procedures are not feasible or desirable. We reviewed 19 patients who had 20 isolated anterior and posterior interosseous neurectomies with no previous or concurrent wrist surgery in a 5-year period at our institution. At an average of 2.5 years postoperatively, 80% of patients reported a decrease in pain, 45% reported normal or increased grip strength, and 73% of employed patients had returned to work. Three patients required additional procedures for pain relief (2 arthrodesis, 1 radial styloidectomies). Failure tended to occur in the first postoperative year. Poor preoperative range of motion and workers' compensation status were predictive of failure. Failure also occurred in the single patient with rheumatoid arthropathy. Two patients had subsequent arthrodeses. There were no complications related to the surgery. Overall, 85% of patients reported satisfaction with this procedure; 90% retrospectively would choose the same treatment for their chronic wrist pain. Partial denervation of the wrist via the anterior and posterior interosseous nerves is a technically easy procedure and may provide pain relief sufficient to markedly delay the need for more extensive salvage procedures in patients with wrist arthritis.
当重建手术不可行或不合适时，部分腕部去神经支配术是治疗慢性腕部疼痛的一种有效的姑息性手术。我们回顾了19例患者，他们在我们机构的5年时间里接受了20例单独的骨间前神经和骨间后神经切除术，之前或同时均未进行过腕部手术。术后平均2.5年时，80%的患者报告疼痛减轻，45%的患者报告握力正常或增加，73%的在职患者已重返工作岗位。3例患者需要额外的手术来缓解疼痛（2例关节融合术，1例桡骨茎突切除术）。失败往往发生在术后第一年。术前活动范围差和工伤赔偿状态是失败的预测因素。类风湿性关节炎患者中唯一的1例也出现了失败。2例患者随后进行了关节融合术。没有与手术相关的并发症。总体而言，85%的患者报告对该手术满意；90%的患者回顾性地表示，若慢性腕部疼痛，他们会选择相同的治疗方法。通过骨间前神经和骨间后神经进行腕部部分去神经支配术是一种技术上简单的手术，对于腕关节炎患者，可能足以缓解疼痛，从而显著推迟进行更广泛挽救手术的需求。
