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  • Title: [Clinical analysis of distal radius core decompression for chronic wrist pain].
    Author: Wu J, Sun J, Liu X, Song J, Hu S, Chen L.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2023 Jul 15; 37(7):815-820. PubMed ID: 37460177.
    Abstract:
    OBJECTIVE: To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies. METHODS: A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI. RESULTS: All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences ( P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up ( P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up. CONCLUSION: For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment. 目的: 探讨桡骨远端髓芯减压术治疗不同病因导致的慢性腕关节疼痛临床疗效。. 方法: 回顾分析2018年1月—2021年12月采用桡骨远端髓芯减压术治疗的10例慢性腕关节疼痛患者临床资料。男6例，女4例；年龄21～55岁，平均37.4岁。病程7～72个月，平均26.5个月。术前MRI检查示10例患侧桡骨远端均存在骨髓水肿，8例舟、月等腕骨存在骨髓水肿。其中3例合并腕部骨折史，2例合并Kienböck病（ⅡB期、ⅢA期各1例）；3例合并三角纤维软骨复合体（triangular fibrocartilage complex，TFCC）1A型损伤；2例合并骨关节炎，其中1例合并严重创伤性关节炎，腕关节镜探查发现TFCC完全缺失无法修复，月骨软骨面及尺骨头软骨均严重磨损。术前、术后6个月及末次随访时，采用疼痛视觉模拟评分（VAS）评价腕关节疼痛缓解情况，并测量患侧腕关节背伸、掌屈、尺偏、桡偏活动度；根据MRI的T1WI序列、T2WI序列及STIR序列评估骨髓水肿程度。. 结果: 术后患者均获随访，随访时间12～22个月，平均16.4个月。除1例患者腕关节疼痛及活动度较术前无明显缓解外，余9例患者疼痛症状基本缓解，腕关节活动度明显改善。术后6个月及末次随访时VAS评分及腕关节背伸、掌屈、尺偏、桡偏活动度均较术前显著改善，末次随访时VAS评分及腕关节尺偏、桡偏活动度较术后6个月进一步改善，差异均有统计学意义（ P<0.05）；术后6个月和末次随访间腕关节背伸、掌屈活动度差异无统计学意义（ P>0.05）。术后6个月MRI检查示6例患者骨髓水肿明显改善，其余患者末次随访时骨髓水肿亦显示好转。. 结论: 对于多种病因导致的腕关节慢性疼痛，桡骨远端髓芯减压术可直接降低桡骨远端骨髓腔压力，改善远端相应结构血供，显著缓解腕关节慢性疼痛，为临床治疗提供了一种选择。.
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