Suresh Visakha, Frost Christopher M, Lifchez Scott D
Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
J Hand Surg Glob Online. 2022 Mar 31;5(1):108-111. doi: 10.1016/j.jhsg.2022.02.005. eCollection 2023 Jan.
Thumb carpometacarpal (CMC) joint osteoarthritis is a common problem affecting up to 85% of patients over the age of 70. The most common presenting symptom for patients with CMC arthritis is pain with joint loading. Loss of function due to subluxation or joint destruction is comparatively rare. Carpometacarpal joint denervation is a relatively novel method for managing CMC arthritis, treating the most impactful symptom: pain.
In this paper, we present a 4- to 6-year follow-up case series on patients who underwent CMC denervation between 2015 and 2017.
Denervation was safe, with less downtime than trapeziectomy with ligament reconstruction with tendon interposition and provided durable complete or partial relief of pain after 5 years in 5 of 9 patients. Four of 9 patients had recurrence of pain by 5 years. Of those with recurrent pain, 3 of 5 eventually underwent trapeziectomy with ligament reconstruction and tendon interposition; the secondary surgery occurred between 17 and 66 months after denervation.
Thumb CMC denervation provides effective relief of arthritis pain that was durable at 5+ years after surgery in more than half of our initial cohort of patients treated. Prospective studies with validated patient-reported and objective outcome measures between distinct treatment arms, such as denervation versus ligament reconstruction with tendon interposition, are needed to firmly establish the role of CMC denervation for patients with symptomatic thumb CMC osteoarthritis.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic/Level IV.
拇指腕掌（CMC）关节骨关节炎是一个常见问题，影响着高达85%的70岁以上患者。CMC关节炎患者最常见的症状是关节负重时疼痛。因半脱位或关节破坏导致的功能丧失相对少见。腕掌关节去神经支配是一种治疗CMC关节炎的相对新颖的方法，可治疗最具影响的症状：疼痛。
在本文中，我们展示了一组对2015年至2017年间接受CMC去神经支配手术患者的4至6年随访病例系列。
去神经支配手术是安全的，与带肌腱间置的韧带重建的大多角骨切除术相比，停机时间更短，并且9名患者中有5名在5年后疼痛得到持久的完全或部分缓解。9名患者中有4名在5年时疼痛复发。在那些疼痛复发的患者中，5名患者中有3名最终接受了带肌腱间置的韧带重建的大多角骨切除术；二次手术在去神经支配术后17至66个月之间进行。
拇指CMC去神经支配能有效缓解关节炎疼痛，在我们最初治疗的患者队列中，超过一半的患者术后5年以上疼痛缓解效果持久。需要通过有效的患者报告和客观结果测量指标，在不同治疗组（如去神经支配与带肌腱间置的韧带重建）之间进行前瞻性研究，以明确CMC去神经支配对有症状的拇指CMC骨关节炎患者的作用。
研究类型/证据水平：治疗性/IV级。
