腕关节慢性疼痛患者的部分腕关节支去神经化治疗  

Treatment of chronic wrist pain by partial wrist denervation

作　　者：李忠哲[1] 杨勇[1] 田文[1] LI Zhong-zhe;YANG Yong;TIAN Wen(Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing,100035,China)

机构地区：[1]北京积水潭医院手外科,100035

出　　处：《中国骨与关节杂志》2022年第12期891-897,共7页Chinese Journal of Bone and Joint

摘　　要：目的 介绍应用部分腕关节神经支去神经化治疗腕关节慢性疼痛的手术方法和临床治疗效果,提出本方法的临床适应证和适用范围。方法 纳入2010年8月至2020年10月就诊于本院,应用部分腕关节神经支切除术(Berger术式)治疗的25例腕关节慢性疼痛、握力显著下降、腕关节功能受限患者。其中舟月进行性塌陷(scapholunate advanced collapse,SLAC)腕3例,舟骨不愈合进行性塌陷(scaphoid non-union advanced collapse,SNAC)腕4例,创伤性腕关节炎2例,月骨缺血坏死4例,炎症性关节炎10例,无明确病因腕关节疼痛2例。本组25例术后均获1.5~8年的随访,平均5.5年。随访指标包括术后腕关节疼痛程度、腕关节活动度、握力、患侧X线检查、是否恢复原工作及对手术的满意度。疼痛视觉模拟评分(visual analogue scale,VAS)评价疼痛程度。腕关节总体功能评价采用上肢功能评分(qaick disabilities of the arm shonlder and hand,DASH)表以及并发症发生情况。结果 32%(8/25)患者获得完全疼痛缓解,48%(12/25)患者获得大部分的疼痛缓解,20%(5/25)患者未获得疼痛缓解或轻度疼痛缓解。腕关节屈伸活动度术后(83%)较术前(65%)有明显提高,桡尺偏活动和旋前旋后活动度术后较术前无明显提高。握力测量术前平均为对侧55%,术后平均为对侧75%,有明显提高。术前VAS评分平均为7.5分,术后平均为1.5分,VAS评分对比差异有统计学意义(P <0.05)。术前DASH评分平均为18分,术后平均为31分,术前与术后之间差异有统计学意义(P <0.05)。本组的全部病例均未发现术后伤口感染、术后感觉及肌力异常、本体感觉异常、痛性神经瘤和复杂局域疼痛综合征、Charcot关节等并发症。术后X线检查中发现48%(12/25)病例出现关节炎的进展,3例由于持续性疼痛进行了翻修手术,2例行局限性关节融合手术,1例行全腕关节融合手术。85%的患者对手术效果满意,90%的患者愿意选择�Objective To introduce the surgical method and clinical effect of denervation of partial wrist nerve branches in the treatment of chronic wrist pain, and to propose the clinical indications and application scope of this method. Methods From August 2010 to October 2020, 25 patients with chronic wrist pain, significantly decreased grip strength and limited wrist joint function were treated by isolated anterior and posterior interosseous neurectomies( modified Berger method). There were 3 cases of SLAC wrist, 4 cases of SNAC wrist, 2 cases of traumatic wrist arthritis, 4 cases of lunate bone ischemic necrosis, 10 cases of inflammatory arthritis and 2 cases of wrist pain without definite cause. All patients were followed up for 1.5 to 8 years( mean: 5.5 years). Follow-up indicators included postoperative wrist pain, wrist range of motion, grip strength, X-ray examination of the affected side, original job restart and surgery satisfaction. Visual analogue scale( VAS) was used to evaluate pain severity. DASH functional evaluation scale was used to evaluate the overall wrist joint function. Complication incidence was recorded. Results Up to 32%( 8/25) of patients achieved complete pain relief, 48%( 12/25) achieved moderate pain relief, and 20%( 5/25) achieved mild pain relief or not. The range of motion of wrist flexion and extension was significantly improved after operation( 83%) compared with that before operation( 65%), while the radiulnar deviation and pronation activity were not significantly improved after operation. The mean value of grip strength was 55% of the contralateral before operation and 75% of the contralateral after operation, which was significantly improved. The mean VAS was decreased from 7.5 preoperatively to 1.5 postoperatively with statistically significant difference( P < 0.05). The mean upper limb function score( DASH) increased from 18 before surgery to 31 after surgery with statistical significance( P < 0.05). No postoperative wound infection, sensory and muscle strength abnormalities,propri

关 键 词：自主神经去神经支配 腕关节 慢性疼痛 

分 类 号：R681.7[医药卫生—骨科学]