Rheumatic Diseases Unit, Centre for Molecular Medicine, The University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK.
Arch Orthop Trauma Surg. 2014 Jul;134(7):1037-44. doi: 10.1007/s00402-014-2018-4. Epub 2014 Jun 7.
Wrist arthrodesis offers high success rates in patients with rheumatoid arthritis; however, loss of residual mobility may cause unnecessary disability. This makes wrist denervation an appealing alternative. However, there is a distinct lack of patient-reported outcome measure studies comparing these two procedures. The aim of this study was to report any change in function, pain and satisfaction following wrist arthrodesis compared to denervation in a single surgeon series of rheumatoid patients.
The results of 16 wrist arthrodesis in 15 patients and 14 partial (PIN) wrist denervations in 13 patients were compared with a mean follow-up period of 39 and 22 months, respectively. The primary outcome measures were the same for both groups and included the validated patient-rated wrist evaluation questionnaire and a satisfaction questionnaire.
Wrist arthrodesis significantly improved the mean total pain and functional outcome scores by 54 and 36 %, respectively, at the time of follow-up. Wrist denervation patients also reported significant improvements of 44 and 42 % in total pain and functional outcomes, respectively; 87 % reported being very satisfied with their wrist arthrodesis procedure compared to 78 % in the denervation group. No statistically significant difference in response between the groups was observed in this series of patients.
Both procedures enjoyed favourable results amongst patients with excellent satisfaction outcomes. PIN denervation is a simple procedure with low complication rates and we therefore consider it a valid alternative to more difficult treatment options, such as partial or total wrist arthrodesis.
腕关节融合术在类风湿关节炎患者中成功率较高，但残余活动度的丧失可能导致不必要的残疾。这使得腕部去神经成为一种有吸引力的选择。然而，比较这两种手术的患者报告的结果测量研究明显缺乏。本研究旨在报告在一位外科医生治疗的一组类风湿关节炎患者中，与去神经相比，腕关节融合术对功能、疼痛和满意度的任何变化。
比较了 15 例患者的 16 例腕关节融合术和 13 例患者的 14 例部分（PIN）腕去神经术的结果，平均随访时间分别为 39 个月和 22 个月。主要的结果测量指标对两组都是相同的，包括经过验证的患者自评腕关节评估问卷和满意度问卷。
腕关节融合术在随访时显著改善了平均总疼痛和功能结局评分，分别为 54%和 36%。腕部去神经患者的总疼痛和功能结局也分别报告了 44%和 42%的显著改善；87%的患者对他们的腕关节融合术非常满意，而在去神经组中这一比例为 78%。在本系列患者中，两组之间的反应没有观察到统计学上的显著差异。
两种手术在患者中都取得了良好的效果，满意度结果极佳。PIN 去神经是一种简单的手术，并发症发生率低，因此我们认为它是一种比部分或全部腕关节融合术等更困难的治疗选择更有效的替代方法。
