Schweizer Andreas, von Känel Oliver, Kammer Erich, Meuli-Simmen Claudia
Division of Plastic, Reconstructive and Hand Surgery, Kantonsspital Aarau AG, Tellstrasse, Aarau, Switzerland.
J Hand Surg Am. 2006 Apr;31(4):559-64. doi: 10.1016/j.jhsa.2005.12.012.
To evaluate the indications and results of complete wrist denervation and to focus on the correlation between results and length of follow-up evaluation.
A retrospective review was performed of 71 complete denervations of the wrist joint in 70 patients with an average follow-up period of 9.6 years (range, 1-23 y) using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The denervations were performed according to the description by Wilhelm. All patients were asked to provide a DASH score. The indications for surgery were degenerative changes caused by scaphoid nonunions (25), distal radius fracture (11), Kienböck's disease (11), primary degenerative arthritis (9), scapholunate dissociation (8), and others (7).
The average DASH score was 26 (range, 0-88). Thirty-nine patients (40 wrists) reported considerable improvement, 8 reported little improvement, and 10 reported temporary improvement after surgery. Seven experienced no change and 6 experienced worsening after surgery. Twenty-two patients were completely free of pain and 13 (14 wrists) had little, 20 had moderate, 11 had considerable, and 4 had severe pain. Forty-eight patients (49 wrists) stated that they would repeat the denervation and 61 (62 wrists) were able to keep their former occupations. There was a trend toward lower (improved) DASH scores in patients with longer follow-up periods but this did not reach statistical significance. The best results were achieved in patients with scapholunate dissociations and the worst results occurred in old distal radius fractures. Patient age did not influence the results. Nine patients with unsatisfactory results needed a second procedure.
Complete wrist denervation resulted in subjective long-term improvement in two thirds and in a complete or marked pain relief in half of the patients. Patients with longer postoperative time and younger age did not affect the results adversely. This procedure is simple and fast, does not decrease range of motion, and leaves all other surgical options open.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.
评估全腕关节去神经支配术的适应证及疗效，并重点关注疗效与随访评估时长之间的相关性。
采用手臂、肩部和手部功能障碍（DASH）问卷，对70例患者的71次全腕关节去神经支配术进行回顾性分析，平均随访时间为9.6年（范围1 - 23年）。去神经支配术按照威廉的描述进行。所有患者均被要求提供DASH评分。手术适应证包括舟骨不愈合导致的退行性改变（25例）、桡骨远端骨折（11例）、月骨无菌性坏死（11例）、原发性退行性关节炎（9例）、舟月关节分离（8例）及其他（7例）。
DASH评分平均为26分（范围0 - 88分）。39例患者（40个腕关节）报告有显著改善，8例改善不明显，10例术后有短暂改善。7例无变化，6例术后病情恶化。22例患者完全无痛，13例（14个腕关节）疼痛轻微，20例中度疼痛，11例疼痛明显，4例疼痛严重。48例患者（49个腕关节）表示愿意再次接受去神经支配术，61例（62个腕关节）能够继续从事之前的职业。随访时间较长的患者DASH评分有降低（改善）趋势，但未达到统计学意义。舟月关节分离患者的疗效最佳，桡骨远端陈旧性骨折患者的疗效最差。患者年龄不影响疗效。9例疗效不满意的患者需要二次手术。
全腕关节去神经支配术使三分之二的患者获得主观长期改善，半数患者疼痛完全或显著缓解。术后时间较长和年龄较轻的患者对疗效无不良影响。该手术操作简单、快速，不减少活动范围，且保留了所有其他手术选择。
研究类型/证据水平：治疗性研究，IV级。
