Clinical And Anatomy Research Of The First Carpometacarpus Denervation

Objective: The first carpometacarpus joint,a saddle-backde joint, islocated in the space between of the first metacarpal basement and thetrapezium. This joint can make various flexible motions: in the coronal axiswhich traverses the first metacarpal basement, it can bend30o-50o, stretched0o-5o; in the sagittal axis which traverses the trapezium, it can adduct0o-5o,and abduce35o-40o. In addition,it can make slight rotation. The thumbfunction can be accounted for40%of the whole hand function. Thecarpomentacarpal joint is the cornerstone of the thumb stability and activity,the largest joint hand joint activities magnitude. Thus the function of the firstcarpometacarpal joint is the most important components of hand function.First carpometacarpal joint dysfunction will seriously affect the function of thehand, which affects the quality of life of the people.Including early conservative treatment further surgery for the treatmentof arthritis of the first carpometacarpal, there is no cure means. Treatment ofearly symptoms mainly rely on non-steroidal anti-inflammatory analgesicdrugs, combined with rest and physical therapy, to relieve paint. For thepatients which have contraindication or poor effects of drug therapy shouldconsider surgery. The purpose of surgery is to relieve paint, increase thestability,mobility of the carpometacarpal joint and the thumb pinching andgripping strength, and to improve the quality of life. There are many methodsof surgical treatment, summed up the main, including the first carpometacarpaljoint fusion, denervation, arthroplasty, artificial joint replacement. All kinds ofoperation each have advantages and disadvantages. Denervation treatmen ofosteoarthritis is increasingly favored by scholars, because of the simplicity ofoperation and the remarkable efficacy of pain relief. In present,for the knee,hip and wrist joints, such as, the research of the denervation see more, but for the carpometacarpal joint less. The purpose of this study is to explore differentsurgical methods for the treatment of first carpometacarpal arthritis clinicalefficacy, and study the peripheral nervers anatomy of the first carpometacarpaljoint, in order to find the appropriate surgical treatment.Method: From2009to2012years,18patients of first carpometacarpalarthritis were used respectively by Joint fusion(7cases), Denervation(5cases),Arthroplasty(6cases), were all be followed up2months-43months, anaverage of17.4months.In the postoperative follow-up, we measured thegripping strength, pinching strength, adductor function, opponeus functionboth hands, evaluated the degree of pain relief, the service condition of thetroubled hand. Then we rated the function by the modifide MAYO.All datasabove were analysed with SPSS software. Then1case of fresh and12cases ofimmersed and fixed by formalin upper limbs were selected. The skin of theseupper limbs was incised in the wrist palm side and back side of radial. Themedian nerve, the superficial branch of the radial nerve, the lateralantebrachial cutaneous nerve of the forearm and these several branches werestripped. Articular branches of the superficial branch of the radial nervr, thelateral antebrachial cutaneous nerve of the forearm, the theanr branch of themedian nerve, the palmar cutaneous branch of the median nerve to the firstcarpometacarpal joint were dissected carefully by the microscopic instrumentsunder the head type surgery microscope. These branches were observation andmeasurement. Incomed datas were analysed with SPSS software.Results:1Results of cases follow:18patients were be followed up from2to43months, average17.4months. The wounds heal well without infection.By the improved MAYO,in the Denerveation group2case was optimal,2casegood,1case approving;in the Joint fusion group1case was optimal,3casegood,1case approving,2case poor;in the Arthroplasty group1case wasoptimal,4case good,1case approving. Pain relief score was no significantdifference among the three groups. About activity range recovery, Arthroplastygroup was significantly better than other two groups. About the gripping andpinching strength recovery, Joint fusion group was better than other two groups.2Anatomical results: The superficial branch of the radial nervr, thelateral antebrachial cutaneous nerve of the forearm, the theanr branch of themedian nerve and the palmar cutaneous branch of the median nerve all issuedjoint branches dominated the first carpometacarpal joint. In accordance withIkiz and Ucerler typing to the superficial branch of the radial nervr,10cases(76.9%) were typeⅠ,2cases(15.4%) were typeⅡ,1case (7.7%) wastype Ⅲ. The articular branches of the superficial branch of the radial nervr,which all comed from the SR2branch and the SR3branch,had3-7(average4.9). These articular branches involved in the range of (18.88±7.98mmproximal to radio styloid to (35.72±8.98) mm distal to radio styloid. Thelateral antebrachial cutaneous nerve of the forearm divided into two branchesat a point (38.24±11.40) mm proximal to radio styloid, which following theradial artery into the nasopharyngeal fossa send out1-3(average2.4) smallbranches into the joint. The palmar cutaneous branch of the median nerve,which comed from the median nerver main at the level (47.81±14.71) mmproximal to radio styloid, send out2-3(average2.6) branches to the palm andthe radialis at the level (8.07±5.10) mm proximal to radio styloid. Theradialis branch passed the radial side flexion wrist tendon had2-4(average3.2)branches into the joint. In10cases (76.9%), the theanr branch of the mediannerve comed from the first side palmar total nerve, but in3cases (23.1%)from the the median nerver main. The theanr branch of the median nervedivided into2-4(average3.4) branches into thenar muscles after it continued(8.28±1.73) mm. These branches acrossed the thenar muscles into thetrapezium. No branche of ulnar nerve was discovered into the carpometacarpaljoint in this study.Conclusion:1The articular branches dominating the carpometacarpaljoint mainly come from the superficial branch of the radial nervr, the lateralantebrachial cutaneous nerve of the forearm, the theanr branch of the mediannerve and the palmar cutaneous branch of the median nerve. And theanatomical structure and the distribution are relatively stable. 2Denervation surgery is the effective treatment of the carpometacarpalarthritis. It can obviously alleviate the pain, further improve the hand withstrength, but it can not improve mobility significantly.