近节指间关节去神经支配术：42 例 54 指的结果。
Denervation of the proximal interphalangeal joint: Results from 54 cases in 42 patients.
机构信息
Unité de Chirurgie de la Main et du Membre Supérieur, Services d'Orthopédie 1 et 2, Hôpital Trousseau, CHRU de Tours, 37044 Tours Cedex, France.
Unité de Chirurgie de la Main et du Membre Supérieur, Services d'Orthopédie 1 et 2, Hôpital Trousseau, CHRU de Tours, 37044 Tours Cedex, France.
出版信息
Orthop Traumatol Surg Res. 2021 Sep;107(5):102976. doi: 10.1016/j.otsr.2021.102976. Epub 2021 Jun 4.
INTRODUCTION
Arthropathy of the proximal interphalangeal joint (PIP) is common. Joint denervation is a symptomatic treatment. It relieves pain by cutting the afferent nerve branches without altering joint biomechanics, and is indicated in painful arthropathy with conserved range of motion. The objective of this study was to evaluate clinical outcome in PIP denervation and the sustainability of results.
HYPOTHESIS
Denervation is an effective intervention in painful PIP arthropathy with functional range of motion, showing lasting benefit.
PATIENTS AND METHODS
A single-center retrospective study included all patients with painful PIP arthropathy with functional range of motion treated by denervation between January 2005 and September 2018 and evaluated by an independent examiner. Joint stiffness was an exclusion criterion. 54 consecutive denervation procedures were performed in 42 patients (41 women, 1 man) with a mean age of 66.5 years (range, 44-78 years). There were 11 inflammatory and 43 degenerative arthropathies.
RESULTS
The 42 patients were evaluated in consultation or contacted by telephone, with a mean follow-up of 51 months (range, 4-168 months). Mean VAS pain score was 7.5/10 (range, 5-10) before the procedure and 1.1/10 (range, 0-8) at last follow-up. Patients considered their joint cured or improved in 78% of cases whatever the etiology (42 cases/54), and in 86% of cases of degenerative arthropathy (37 cases/43). 32 patients were satisfied or very satisfied with the intervention (76% of cases). Active range of motion was improved in 16 cases, unchanged in 33 and impaired in 5. There were 7 denervation failures, which led to surgical treatment by fusion (2 cases) or joint replacement (5 cases); 5 of these cases concerned arthropathy of inflammatory origin.
CONCLUSION
Denervation is an effective treatment for painful PIP osteoarthritis, providing lasting pain relief while conserving range of motion.
LEVEL OF EVIDENCE
IV; retrospective study.
简介
近端指间关节（PIP）的关节病很常见。关节去神经支配是一种对症治疗方法。它通过切断感觉神经分支来缓解疼痛，而不改变关节生物力学，适用于运动范围保持的疼痛性关节病。本研究的目的是评估 PIP 去神经支配的临床效果及其结果的可持续性。
假设
去神经支配是一种有效的治疗方法，可用于治疗有功能运动范围的疼痛性 PIP 关节炎，并可提供持久的益处。
患者和方法
一项单中心回顾性研究纳入了 2005 年 1 月至 2018 年 9 月间因疼痛性 PIP 关节炎伴功能运动范围接受去神经支配治疗的所有患者，并由独立的检查者进行评估。关节僵硬是排除标准。42 例患者（41 名女性，1 名男性）接受了 54 例连续的去神经支配手术，平均年龄为 66.5 岁（范围，44-78 岁）。其中 11 例为炎症性关节炎，43 例为退行性关节炎。
结果
42 例患者在就诊时或通过电话接受了评估，平均随访时间为 51 个月（范围，4-168 个月）。术前平均 VAS 疼痛评分为 7.5/10（范围，5-10），末次随访时为 1.1/10（范围，0-8）。无论病因如何（42 例/54 例），78%的患者认为自己的关节已治愈或改善，退行性关节炎（37 例/43 例）中 86%的患者认为自己的关节已治愈或改善。32 例患者（76%的病例）对干预措施感到满意或非常满意。主动活动范围在 16 例患者中得到改善，在 33 例患者中保持不变，在 5 例患者中受损。有 7 例去神经支配失败，导致融合（2 例）或关节置换（5 例）手术治疗；其中 5 例为炎症性关节炎。
结论
去神经支配是治疗疼痛性 PIP 骨关节炎的有效方法，可提供持久的疼痛缓解，同时保持运动范围。
证据等级
IV；回顾性研究。
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