Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, 1, rue de Germont, 76000 Rouen, France.
Department of Plastic, Reconstructive Surgery, Hopital Privé de l'Estuaire, 505, rue Irène Joliot-Curie, 76620 Le Havre, France.
Hand Surg Rehabil. 2020 Sep;39(4):239-250. doi: 10.1016/j.hansur.2020.02.005. Epub 2020 Mar 20.
In cases of osteoarthritis with preserved motion, joint denervation can be an effective alternative to arthroplasty or arthrodesis to reduce joint-related pain. Although denervation is a standardized procedure for wrist osteoarthritis, it is used sparingly for finger joints. We conducted a systematic review to summarize reported cases of finger joint denervation in hand osteoarthritis with a specific focus on surgical procedures and postoperative outcomes. PubMed, Cochrane and Science Direct databases were searched from 1998 to 2019 and 13 relevant articles were selected. Three hundred and twenty-five denervations were conducted on 291 patients. Distal interphalangeal (DIP) joint denervation was performed through a dorsal approach; 83% of patients were satisfied with the surgery and complications occurred in 58%. Proximal interphalangeal (PIP) joint denervation was performed through a palmar approach; 90% of patients were satisfied with the surgery; complications were observed in 14%. Good results were observed in 95% of patients who underwent metacarpophalangeal (MCP) joint denervation; complications were observed in 26%; denervation was carried out with dorsal and palmar approaches in all cases. Denervation of the trapeziometacarpal (TMC) joint was achieved through the Wagner approach (61%), multiple incisions (26%), or dorsal approach (13%); satisfaction rate was 91%, with a 6% complication rate. Finger joint denervation in hand osteoarthritis is a simple and effective procedure, providing satisfactory pain relief. Good results are reported in all studies, especially for PIP and TMC joint denervation. Further investigations should be conducted on DIP and MCP joint denervation.
对于运动功能保存的骨关节炎病例，关节去神经支配可作为关节置换或关节融合术的有效替代方法，以减轻关节相关疼痛。尽管去神经支配是腕骨关节炎的标准化手术程序，但很少用于手指关节。我们进行了一项系统评价，以总结手部骨关节炎手指关节去神经支配的报告病例，重点关注手术过程和术后结果。从 1998 年到 2019 年，我们检索了 PubMed、Cochrane 和 Science Direct 数据库，共选择了 13 篇相关文章。291 名患者共进行了 325 次去神经支配。通过背侧入路进行远侧指间关节（DIP）关节去神经支配；83%的患者对手术满意，58%发生并发症。通过掌侧入路进行近侧指间关节（PIP）关节去神经支配；90%的患者对手术满意，观察到 14%的并发症。95%接受掌指关节（MCP）关节去神经支配的患者获得良好结果，观察到 26%的并发症；所有病例均采用背侧和掌侧入路进行去神经支配。通过 Wagner 入路（61%）、多切口（26%）或背侧入路（13%）实现了腕掌关节（TMC）关节去神经支配；满意度为 91%，并发症发生率为 6%。手部骨关节炎手指关节去神经支配是一种简单有效的方法，可提供满意的疼痛缓解。所有研究均报告了良好的结果，尤其是 PIP 和 TMC 关节去神经支配。应进一步研究 DIP 和 MCP 关节去神经支配。
