目的:手掌(CMC)关节去神经支配是通过选择性切断CMC关节的关节神经分支来治疗骨关节炎相关疼痛的一种相对新颖的方法。这项研究比较了CMC去神经支配后的功能/患者报告的结果,以及在2年的随访期内进行梯形切除术和肌腱介入(TLRTI)的韧带重建后的结果。我们假设在研究过程中和最后的2年随访中,去神经和T+LRTI的结果是相似的。
方法:患有伊顿2-4期疾病的成年人,没有CMC半脱位的证据,并且不包括拇指损伤/手术史.疼痛评分,简短的密歇根手问卷(bMHQ),卡潘吉得分,两点歧视,和抓地力/键/3点夹紧强度测量为3,6-,12-,手术后24个月.平均而言,T+LRTI患者接受7周的夹板,在3个月时释放到完全活动;去神经的患者被放置在柔软的术后敷料中2周,在3周时可耐受释放至完全活性。
结果:纳入33例去神经和20例T+LRTI患者。两组的术前特征相似。在研究期间,两名去神经支配患者接受了继发性TLRTI;一名去神经支配患者在外部机构接受了CMC关节的脂肪移植。二次手术前的数据包括在分析中。去神经和T+LRTI的平均止血带时间(分钟)分别为43.5±11.8和82.7±14.2分钟,分别。对于去神经和T+LRTI,术后bMHQ评分在所有时间点均显著高于基线.两组bMHQ之间没有发现显着差异,感觉,或强度措施。
结论:腕掌神经支配的耐受性良好,与T+LRTI相比,止血带时间更短,恢复完全活动更快。对于研究队列,2年时T+LRTI的转化率为9%。与手术前状态相比,两种手术均显示bMHQ的持久改善,在2年的随访中具有相似的长期结果。
方法:治疗II。
Thumb carpometacarpal (CMC) joint denervation is a relatively novel method for the management of osteoarthritis-associated pain by selective transection of articular nerve branches of the CMC joint. This
study compared functional/patient-reported outcomes after CMC denervation with those after trapeziectomy and ligament reconstruction with tendon interposition (T + LRTI) over a 2-year follow-up period. We hypothesized that the outcomes of denervation and T + LRTI would be similar over the course of the
study and at the final 2-year follow-up.
Adults with Eaton stage 2-4 disease, no evidence of CMC subluxation, and no history of thumb injury/surgery were included. Pain scores, brief Michigan Hand Questionnaire (bMHQ), Kapandji score, 2-point discrimination, and grip/key/3-point pinch strength were measured at 3-, 6-, 12-, and 24-months after surgery. On average, T + LRTI patients underwent 7 weeks of splinting, with release to full activity at 3 months; denervation patients were placed in a soft postoperative dressing for 2 weeks, with release to full activity as tolerated at 3 weeks.
Thirty-three denervation and 20 T + LRTI patients were included. Preoperative characteristics were similar between both groups. Two denervation patients underwent secondary T + LRTI during the
study period; one denervation patient underwent fat grafting to the CMC joint at an outside institution. Data prior to secondary surgeries were included in the analysis. The average tourniquet times (minutes) for denervation and T + LRTI were 43.5 ± 11.8 and 82.7 ± 14.2 minutes, respectively. For denervation and T + LRTI, the postoperative bMHQ scores were significantly higher than those at baseline at all time points. No significant differences were found between both groups for bMHQ, sensation, or strength measures.
Carpometacarpal denervation is well tolerated, with shorter tourniquet times and faster return to full activity than T + LRTI. For the
study cohort, the conversion rate to T + LRTI at 2 years was 9%. Both procedures demonstrated durable improvement in bMHQ compared with the preoperative state with similar long-term outcomes over 2 years of follow-up.
Therapeutic II.