Dellon A Lee
Baltimore, Md. From Johns Hopkins University.
Plast Reconstr Surg. 2009 Jan;123(1):197-207. doi: 10.1097/PRS.0b013e31818cc23f.
Partial joint denervation is the concept of preservation of joint function and relief of joint pain by interrupting the neural pathways that transmit the pain message from the joint to the brain. When traditional, nonoperative, musculoskeletal approaches fail, the surgical approach may require joint fusion or replacement arthroplasty. The purpose of this article is to extend these concepts from the wrist to the elbow and shoulder.
For each joint, research required (1) anatomical dissection to identify innervation of the specific joint, (2) identification of route through which to administer local anesthetic based on new anatomical knowledge, (3) demonstration that pain relief is possible by injection of local anesthetic in patients who have failed traditional musculoskeletal treatments for that joint, (4) creation of surgical approach(es) to resect involved nerve(s), and (5) documentation of success of this approach with an appropriate patient population.
The results obtained for partial joint denervation of the wrist can be applied successfully to the elbow and shoulder. If anesthetic block of joint innervation results in greater than or equal to a five-point reduction in visual analogue scale score, 90 percent of the patients can expect good to excellent pain relief from partial joint denervation.
Partial joint denervation offers an outpatient, ambulatory operative approach that is joint sparing and rehabilitation free. For plastic surgery, this concept opens new areas for patient care, permitting relief of pain and restoration of function to joints even proximal to the wrist, permitting plastic surgeons to bring this hope to our orthopedic and pain management colleagues.
部分关节去神经支配是一种通过中断将疼痛信号从关节传递至大脑的神经通路来保留关节功能并缓解关节疼痛的理念。当传统的非手术性肌肉骨骼治疗方法失败时，手术方法可能需要关节融合或置换关节成形术。本文的目的是将这些理念从腕关节扩展至肘关节和肩关节。
对于每个关节，研究需要（1）进行解剖 dissection 以识别特定关节的神经支配，（2）根据新的解剖学知识确定局部麻醉药的给药途径，（3）证明在针对该关节的传统肌肉骨骼治疗失败的患者中，通过注射局部麻醉药可实现疼痛缓解，（4）创建切除受累神经的手术方法，以及（5）在合适的患者群体中记录该方法的成功情况。
腕关节部分关节去神经支配所获得的结果可成功应用于肘关节和肩关节。如果关节神经支配的麻醉阻滞导致视觉模拟量表评分降低大于或等于 5 分，则 90%的患者有望通过部分关节去神经支配获得良好至极佳的疼痛缓解。
部分关节去神经支配提供了一种门诊、可走动的手术方法，该方法保留关节且无需康复治疗。对于整形外科而言，这一理念为患者护理开辟了新领域，即使对于腕关节近端的关节，也能实现疼痛缓解和功能恢复，使整形外科医生能够将这种希望带给我们的骨科和疼痛管理同行。
