Hand Surgery Department of Beijing Jishuitan Hospital, Beijing, China.
Orthop Surg. 2023 Jul;15(7):1831-1838. doi: 10.1111/os.13762. Epub 2023 Jun 29.
Undifferentiated chronic monosecarthritis (UCMA) is a group of inflammatory joint diseases that has the potential to progress to other diseases and can seriously affect patients' quality of life. There is yet no unified consensus regarding treatment of UCMA. This study aimed to investigate the efficacy of arthroscopic synovectomy combined with partial wrist denervation in treating Larsen 1-3 UCMA.
In this case series, we reviewed 14 patients with UCMA treated by arthroscopic synovectomy combined with partial denervation from February 2017 to June 2020. The mean duration of symptoms was 17.4 months (range, 4-60 months), and the mean follow-up was 13.3 months (range, 6-23 months). The anterior and posterior interosseous nerves were severed at the distal forearm, and the radiocarpal, midcarpal, and distal radial ulnar joint synovial membranes were arthroscopically resected at the wrist. The clinical evaluation indices included the visual analogue scale score (VAS) for pain, grip strength, range of (active) motion of the wrist, total active motion, and Mayo wrist score. Larsen's scoring method was used as the imaging evaluation index.
At the last follow-up, significant clinical improvements were observed in the visual analogue scale (VAS) score for pain (6.0 (5.0-6.3) vs 1.0 (1.0-2.3), P = 0.001) and Mayo wrist score (42.1 ± 9.7 vs 61.8 ± 12.3, P < 0.0001). No significant changes were found in grip strength (15.9 ± 4.5 vs 16.6 ± 4.7, P = 0.230) or the flexion-extension arc (58.9 ± 39.0 vs 64.3 ± 36.5, P = 0.317), although the mean and median did show positive changes. Among the three patients who showed progress in imaging, there was no significant difference in their pain and functional scores compared to those who did not progress. One patient underwent total wrist fusion 17 months after the operation.
Arthroscopic wrist synovectomy combined with partial wrist denervation can provide sustained pain relief and functional recovery for patients with Larsen 1-3 UCMA.
未分化慢性单关节炎（UCMA）是一组具有发展为其他疾病潜力的炎性关节疾病，可严重影响患者的生活质量。目前对于 UCMA 的治疗还没有统一的共识。本研究旨在探讨关节镜滑膜切除术联合腕关节部分去神经支配术治疗 Larsen 1-3 型 UCMA 的疗效。
本病例系列研究回顾性分析了 2017 年 2 月至 2020 年 6 月期间采用关节镜滑膜切除术联合部分腕关节去神经支配术治疗的 14 例 UCMA 患者。症状持续时间平均为 17.4 个月（4-60 个月），平均随访时间为 13.3 个月（6-23 个月）。在前臂远端切断正中神经和尺神经的骨间前、后神经，在腕关节行桡腕、腕中、腕尺侧关节滑膜切除术。临床评估指标包括疼痛视觉模拟评分（VAS）、握力、腕关节主动活动度（屈伸）、总主动活动度和 Mayo 腕关节评分。采用 Larsen 评分法作为影像学评估指标。
末次随访时，疼痛 VAS 评分（6.0[5.0-6.3]比 1.0[1.0-2.3]，P=0.001）和 Mayo 腕关节评分（42.1±9.7 比 61.8±12.3，P<0.0001）均有显著改善。握力（15.9±4.5 比 16.6±4.7，P=0.230）和屈伸活动度（58.9±39.0 比 64.3±36.5，P=0.317）无明显变化，但均值和中位数均呈阳性变化。在影像学进展的 3 例患者中，与未进展的患者相比，其疼痛和功能评分无显著差异。1 例患者术后 17 个月行全腕关节融合术。
关节镜下腕关节滑膜切除术联合腕关节部分去神经支配术可缓解 Larsen 1-3 型 UCMA 患者的疼痛，促进其功能恢复。
