From the Departments of Plastic and Reconstructive Surgery and Rehabilitation Medicine, Erasmus Medical Center-University Medical Centre.
Plast Reconstr Surg. 2021 Dec 1;148(6):959e-972e. doi: 10.1097/PRS.0000000000008517.
Joint denervation of the wrist, basal joint of the thumb, and the finger is an option for patients with chronic pain. Compared with other surgical treatment options, function is preserved and the rehabilitation time is limited. A systematic review and meta-analysis were performed for each joint to determine whether the choice of technique and choice of denervation of specific articular sensory branches lead to a different outcome.
Embase, MEDLINE (OvidSP), Web of Science, Scopus, PubMed publisher, Cochrane, and Google Scholar database searches yielded 17 studies with reported outcome on denervation of the wrist, eight on the basal joint of the thumb, and five on finger joints.
Overall, the level of evidence was low; only two studies included a control group, and none was randomized. Meta-analysis for pain showed a 3.3 decrease in visual analogue scale score for wrist pain. No difference was found between techniques (total versus partial denervation), nor did different approaches influence outcome. The first carpometacarpal joint showed a decrease for visual analogue scale score for pain of 5.4. Patient satisfaction with the treatment result was 83 percent and 82 percent, respectively. Reported pain in finger joints decreased 96 percent in the metacarpophalangeal joints, 81 percent in the proximal interphalangeal joint, and 100 percent in the distal interphalangeal joint. The only reported case in the metacarpophalangeal joint of the thumb reported an increase of 37 percent.
Only denervation of the metacarpophalangeal joint of the thumb reported an increase in pain; however, this was a single patient. Wrist and first carpometacarpal joint and finger joint denervation have a high satisfaction rate and decrease the pain. There was no difference between techniques.
腕关节、拇指基底部关节和手指的联合去神经支配是慢性疼痛患者的一种选择。与其他手术治疗方法相比，该方法保留了功能，康复时间有限。对每个关节进行了系统评价和荟萃分析，以确定技术选择和特定关节感觉分支去神经支配的选择是否导致不同的结果。
在 Embase、MEDLINE（OvidSP）、Web of Science、Scopus、PubMed 出版商、Cochrane 和 Google Scholar 数据库中进行了检索，共获得 17 项关于腕关节、8 项关于拇指基底部关节和 5 项关于手指关节去神经支配的报道结果的研究。
总体而言，证据水平较低；只有两项研究包括对照组，且均未进行随机分组。腕关节疼痛的视觉模拟评分（VAS）的荟萃分析显示疼痛降低了 3.3。技术之间（完全去神经与部分去神经）没有差异，不同方法也没有影响结果。第一腕掌关节的 VAS 评分疼痛降低了 5.4。患者对治疗结果的满意度分别为 83%和 82%。指间关节的疼痛报告降低了 96%在掌指关节，81%在近指间关节，100%在远指间关节。拇指掌指关节唯一报告的病例疼痛增加了 37%。
只有拇指掌指关节的去神经支配报告疼痛增加；然而，这只是一个病例。腕关节、第一腕掌关节和指间关节去神经支配的满意度高，疼痛减轻。技术之间没有差异。
