Foucher G, Long Pretz P, Erhard L
Chirurgie. 1998 Apr;123(2):183-8. doi: 10.1016/s0001-4001(98)80104-9.
In patients with preserved mobility and stability a painful joint remains a difficult problem, especially in elderly patients. All operations, including intracarpal arthrodesis, reduce an already limited mobility, require prolonged immobilization and have a high rate of complications. Denervation could be proposed in such cases.
In our study denervation was performed on 132 wrists, 36 first carpo-metacarpal joints and 32 proximal inter-phalangeal joints.
We have been disappointed in the past by partial wrist denervations. Fifty cases of complete and isolated wrist denervation were reviewed with a mean 5-year followup. Strength and mobility were only marginally improved but pain was decreased by a mean 75% (on a visual analog scale) in 74% of patients. At the proximal inter-phalangeal joint level, the mean pain improvement was 88% in 85% of patients. At the first carpo-metacarpal joint level, results of denervation were less predictable and the mean pain improvement was 67% in 81% of patients, with a mean 17-month follow-up.
Joint denervation is a simple but precise operation performed under local anesthesia and on an outpatient basis. It provides good results in elderly patients, with few complications.
在活动能力和稳定性尚可的患者中，疼痛性关节仍是一个难题，尤其是在老年患者中。所有手术，包括腕骨间关节融合术，都会降低本就有限的活动能力，需要长时间固定，且并发症发生率高。在这种情况下可考虑进行去神经支配术。
在我们的研究中，对132个腕关节、36个第一腕掌关节和32个近端指间关节进行了去神经支配术。
过去我们对部分腕关节去神经支配术的效果并不满意。对50例完全性孤立性腕关节去神经支配术病例进行了回顾，平均随访5年。力量和活动能力仅有轻微改善，但74%的患者疼痛平均减轻了75%（采用视觉模拟评分法）。在近端指间关节水平，85%的患者疼痛平均改善率为88%。在第一腕掌关节水平，去神经支配术的效果较难预测，平均随访17个月，81%的患者疼痛平均改善率为67%。
关节去神经支配术是一种在局部麻醉下门诊进行的简单而精确的手术。它在老年患者中效果良好，并发症少。
