Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France.
Service de chirurgie orthopédique et traumatologique, avenue Yves Thépot, Centre Hospitalier De Cornouaille, 29107 Quimper, France.
Orthop Traumatol Surg Res. 2021 Sep;107(5):102967. doi: 10.1016/j.otsr.2021.102967. Epub 2021 May 24.
Pain is the main reason why patients consult for degenerative and posttraumatic wrist conditions. While the many surgical techniques make choosing the appropriate procedure difficult, total wrist denervation, which has an "analgesic" aim, remains an accessible therapeutic solution to treat this symptomatology. Nevertheless, long-term results remain controversial, and few studies have focused on the survival of this procedure.
Total wrist denervation provides lasting pain relief.
This was a single center, single operator (DLN), retrospective observational study. We analyzed 63 wrists. The mean age at the time of the procedure was 53.7 years. We verified the primary endpoint for survival, which included no further analgesic procedures and no significant residual pain (NRS≤3). Patient satisfaction and the quality of the wrist function were also assessed.
The mean follow-up was 8.2 years. Some of the patients (12.7%) did not respond to treatment. We reported 1 neuroma of the superficial sensory branch of the radial nerve, 2 CRPS and 11 revision surgeries. We observed that the treatment became less effective over time. The median survival was 8.8 years. The survival rate of the procedure fell to 13.5% at the last follow-up. The mean residual pain was 3.4 on a numerical rating scale and the mean DASH score was 23.5. The mean satisfaction level, on a scale from 0 to 10, was 7.3 and most patients (79.6%) would undergo this procedure again.
Survival of the total wrist denervation at the last follow-up was low in our study. Even though the treatment became less effective over time, the quality of the wrist function remained satisfactory and similar to the different studies previously published on the subject. There were very few complications and revisions.
Total wrist denervation therefore remains an interesting surgical solution for patients with chronic wrist pain as it preserves mobility.
IV; Single center, single operator retrospective observational study.
疼痛是患者因退行性和创伤后腕部疾病就诊的主要原因。虽然有许多手术技术，但选择合适的手术方法仍然具有挑战性，而腕部完全去神经支配术（旨在缓解疼痛）作为一种可行的治疗方法，可以用于治疗这种症状。然而，长期结果仍存在争议，且很少有研究关注该手术的存活率。
腕部完全去神经支配术可提供持久的疼痛缓解。
这是一项单中心、单手术医生（DLN）回顾性观察研究。我们分析了 63 个腕关节。手术时的平均年龄为 53.7 岁。我们验证了主要的生存终点，包括无进一步的镇痛治疗和无明显残留疼痛（NRS≤3）。还评估了患者满意度和腕关节功能的质量。
平均随访时间为 8.2 年。部分患者（12.7%）对治疗无反应。我们报告了 1 例桡神经浅感觉支神经瘤、2 例复杂性区域疼痛综合征和 11 例翻修手术。我们观察到治疗效果随时间推移而降低。该手术的中位生存期为 8.8 年。在最后一次随访时，该手术的存活率降至 13.5%。平均残留疼痛评分为 3.4（数字评分量表），平均 DASH 评分为 23.5。平均满意度评分（0-10 分）为 7.3，大多数患者（79.6%）会再次接受该手术。
在我们的研究中，腕部完全去神经支配术的最终存活率较低。尽管治疗效果随时间推移而降低，但腕关节功能的质量仍然令人满意，与之前发表的关于该主题的不同研究相似。并发症和翻修手术很少见。
因此，对于患有慢性腕痛的患者，腕部完全去神经支配术仍然是一种有趣的手术解决方案，因为它可以保留活动度。
IV；单中心、单手术医生回顾性观察研究。
