Simon E, Zemirline A, Richou J, Hu W, Le Nen D
Service de chirurgie orthopédique traumatologique et réparatrice, CHU de Brest, 29200 Brest, France.
Chir Main. 2012 Dec;31(6):306-10. doi: 10.1016/j.main.2012.07.005. Epub 2012 Aug 9.
Complete wrist denervation is a palliative operation, which yields still controversial outcomes. The aim of our study is to assess the late outcomes of complete wrist denervation.
In a retrospective continuous review of 27 complete and isolated denervations of the wrist joint performed by the same surgeon in 27 patients (15 men for 12 women) from 1995 to 2007, the pain (VAS), the function (Dash-score), the range of motion, the strength (Jamar) and the radiological changes were assessed at a mean follow-up period of 77 months (12 to 157).
At final follow-up, 12 patients (44%) were completely free of pain and 11 (41%) had little pain, four (15%) had moderate and severe pain. The average time to achieve the complete pain relief was 3 months and 3 weeks. Pain relief was stable over time in 89% of cases. There was a significant improvement in range of motion: 11° flexion/extension; 8° pronosupination. In average, the Jamar grip strength was 85% of the healthy side. The Dash-score was in average 30.4 (22 to 60). The extension of the osteoarthritic surface was observed in 14 patients (52%). Six complications were noted: one complex regional pain syndrome, five neuromas four of which resolved spontaneously. Two patients were re-operated. Eighteen patients were very satisfied (67%), six patients were satisfied (22%) and three patients were moderately satisfied (11%).
Complete wrist denervation is an intervention with few complications indicated in chronic wrist pain of any aetiology.
完全性腕关节去神经支配术是一种姑息性手术，其效果仍存在争议。本研究的目的是评估完全性腕关节去神经支配术的远期疗效。
对1995年至2007年同一位外科医生为27例患者（15例男性，12例女性）实施的27例完全性孤立性腕关节去神经支配术进行回顾性连续分析，在平均随访77个月（12至157个月）时评估疼痛（视觉模拟评分法）、功能（上肢功能障碍评分系统评分）、活动范围、力量（Jamar握力计）及影像学改变。
末次随访时，12例患者（44%）完全无痛，11例患者（41%）轻度疼痛，4例患者（15%）中度及重度疼痛。达到完全疼痛缓解的平均时间为3个月零3周。89%的病例疼痛缓解随时间保持稳定。活动范围有显著改善：屈伸增加11°；旋前旋后增加8°。Jamar握力平均为健侧的85%。上肢功能障碍评分系统评分平均为30.4（22至60）。14例患者（52%）观察到骨关节炎表面扩展。记录到6例并发症：1例复杂性区域疼痛综合征，5例神经瘤，其中4例自发缓解。2例患者再次手术。18例患者非常满意（67%），6例患者满意（22%），3例患者中度满意（11%）。
完全性腕关节去神经支配术是一种并发症少的干预措施，适用于任何病因引起的慢性腕关节疼痛。
