Abstract：
Joint denervation has been proposed as a less invasive option for surgical management of hand arthritis that preserves joint anatomy while treating pain and decreasing postoperative recovery times. The purpose of this systematic review was to investigate the efficacy and safety of surgical joint denervation for osteoarthritis in the joints of the hand. EMBASE, MEDLINE, and PubMed databases were searched from January 2000 to March 2019. Studies of adult patients with rheumatoid arthritis or osteoarthritis of the hand who underwent joint denervation surgery were included. Two reviewers performed the screening process, data abstraction, and risk of bias assessment (Methodological Index for Non-Randomized Studies). This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (#125811). Ten studies were included, 9 case series and 1 cohort study, with a total of 192 patients. In all studies, joint denervation improved pain and hand function at follow-up (M = 36.8 months, range = 3-90 months). Pooled analysis of 3 studies on the first carpometacarpal joint showed a statistically significant (P < .001) reduction in pain scores from baseline (M = 6.61 ± 2.03) to postoperatively (M = 1.69 ± 1.27). The combined complication rate was 18.8% (n = 36 of 192), with neuropathic pain or unintended sensory loss (8.8%, n = 17 of 192) being the most common. This review suggests that denervation may be an effective and low-morbidity procedure for treating arthritis of the hand. Prospective, comparative studies are required to further understand the outcomes of denervation compared with traditional surgical interventions.
摘要：
已提出关节神经支配术作为手关节炎的外科治疗的侵入性较小的选择，可保留关节解剖结构，同时治疗疼痛并减少术后恢复时间。本系统评价的目的是探讨手术关节去神经治疗手关节骨关节炎的疗效和安全性。EMBASE,MEDLINE,和PubMed数据库从2000年1月至2019年3月进行了搜索。包括接受关节神经支配手术的类风湿关节炎或手部骨关节炎的成年患者的研究。两名审稿人进行了筛选过程，数据抽象，和偏倚风险评估(非随机研究的方法学指数)。该评价遵循系统评价和荟萃分析指南的首选报告项目，并在PROSPERO（＃125811）注册。包括10项研究，9个病例系列和1个队列研究，共192名患者。在所有研究中,关节神经支配在随访时改善疼痛和手功能（M=36.8个月，范围=3-90个月)。对3项关于第一腕掌关节的研究进行汇总分析显示，疼痛评分从基线（M=6.61±2.03）到术后（M=1.69±1.27）有统计学意义（P<.001）。合并并发症发生率为18.8%(n=36/192),伴有神经性疼痛或意外感觉丧失(8.8%，n=192中的17）是最常见的。这篇综述表明，去神经支配可能是治疗手关节炎的有效且低发病率的方法。前瞻性,需要进行比较研究,以进一步了解与传统手术干预相比去神经的结局.
