Loréa P, Dury M, Marin Braun F, Dekkaï T, De Mey A, Foucher G
Laboratoire de chirurgie plastique expérimentale, Fondation médicale Reine Elisabeth, CHU Brugmann, place Van Gehuchten, 4, 1020 Bruxelles, Belgique.
Chir Main. 2002 Jul;21(4):209-17. doi: 10.1016/s1297-3203(02)00115-4.
The main goal of first carpometacarpal arthritis surgical treatment is to relieve pain. The main disadvantages of the usual techniques (trapeziectomy, implant arthroplasty) are loss of strength or presence of a prosthetic device. It is difficult to propose such extensive surgery at an early stage of the disease. Selective denervation of the first carpometacarpal joint seems to be an interesting choice. We propose a new technique of denervation based on our previous anatomical investigations.
Two incisions are needed to cut all the articular branches derive from the superficial branch of the radial nerve, the palmar cutaneous branch of the median nerve, the thenar branch of the median nerve and the lateral ante brachial cutaneous nerve.
Fourteen patients were prospectively included in our study with a mean follow-up of 5 months.
Pain relief was very satisfying in 12 cases (mean decrease 84%). An increase in grip and key pinch strength was noted. Complications were uncommon, excepted temporary paresthésia in the radial nerve area.
This technique seems to be promising and a good indication for patients with no disabling deformity, but only long-term results will confirm the place of denervation in the treatment of first carpometacarpal arthritis.
第一掌腕关节关节炎手术治疗的主要目标是缓解疼痛。常用技术（大多角骨切除术、植入物置换术）的主要缺点是力量丧失或存在假体装置。在疾病早期很难推荐如此广泛的手术。第一掌腕关节选择性去神经支配似乎是一个有趣的选择。基于我们之前的解剖学研究，我们提出一种新的去神经支配技术。
需要两个切口来切断源自桡神经浅支、正中神经掌皮支、正中神经鱼际支和前臂外侧皮神经的所有关节支。
14例患者前瞻性纳入我们的研究，平均随访5个月。
12例患者疼痛缓解非常令人满意（平均减轻84%）。握力和捏力增加。并发症不常见，除了桡神经区域的暂时性感觉异常。
这项技术似乎很有前景，对于没有致残畸形的患者是一个很好的适应症，但只有长期结果才能确定去神经支配在第一掌腕关节关节炎治疗中的地位。
