Department of Orthopedic Surgery, "Federico II" University, Via S. Pansini 5, bd. 12, 80131 Napoli, Italy.
Department of Orthopedic Surgery, "Federico II" University, Via S. Pansini 5, bd. 12, 80131 Napoli, Italy.
Hand Surg Rehabil. 2020 Dec;39(6):487-491. doi: 10.1016/j.hansur.2020.05.010. Epub 2020 Jul 10.
The aim of this systematic review was to understand which procedure-total or partial wrist denervation-provides better results in terms of pain relief and function. This review was registered on PROSPERO (CRD42018088856). We searched the Medline (PubMed), Web of Science and Scopus databases. Twenty-one studies were included in this review. We assessed the quality of the studies using the Coleman Methodological Score. Data on demographics, surgical indications, diagnostic methods, follow-up periods, type and rates of complications, survivorship of the procedure, return to work, and outcome measures were recorded. A total of 1065 patients were included in this review; the mean quality of the studies included was considered poor. The outcomes could not be analyzed because none of the studies had reliable outcome data reported, but both procedures were effective in terms of pain relief and range of motion. Partial wrist denervation has an average subsequent procedure rate of 19%. Total wrist denervation had an average subsequent procedure rate of 4.7%. No complications were reported in any patient who underwent partial wrist denervation versus 20 patients who underwent total wrist denervation. Both partial and total wrist denervation are safe and reliable procedures that can provide good pain relief and preserve wrist range of motion. Total wrist denervation offers better long-term outcomes in term of pain relief, with fewer subsequent procedures being needed compared to partial denervation, and with a low complication rate. LEVEL OF EVIDENCE: Level III, Systematic review, Therapeutic.
本系统评价的目的是了解全腕或部分腕神经切断术在缓解疼痛和功能方面的效果。本研究已在 PROSPERO（CRD42018088856）注册。我们检索了 Medline（PubMed）、Web of Science 和 Scopus 数据库。本研究共纳入了 21 项研究。我们使用 Coleman 方法学评分评估了研究的质量。记录了人口统计学、手术适应证、诊断方法、随访时间、并发症类型和发生率、手术存活率、重返工作岗位以及结果测量等数据。本研究共纳入了 1065 例患者；纳入研究的平均质量被认为较差。由于没有研究报告可靠的结果数据，因此无法进行结果分析，但两种手术在缓解疼痛和改善活动范围方面均有效。部分腕神经切断术后的平均后续手术率为 19%。全腕神经切断术后的平均后续手术率为 4.7%。与接受全腕神经切断术的 20 例患者相比，接受部分腕神经切断术的患者无并发症报告。部分和全腕神经切断术均为安全可靠的手术，可以提供良好的疼痛缓解效果，并保留腕关节活动范围。与部分切断术相比，全腕神经切断术在缓解疼痛方面具有更好的长期效果，需要进行的后续手术较少，且并发症发生率较低。证据等级：III 级，系统评价，治疗性。
