超声引导下膝周神经脉冲射频治疗膝骨关节炎患者的疗效  

Efficacy of ultrasound-guided peri-genicular nerve pulsed radiofrequency in the treatment of patients with knee osteoarthritis

作　　者：吴军珍[1] 吕莹莹[1] 李晨 杜冬萍[1] Wu Junzhen;Lyu Yingying;Li Chen;Du Dongping(Department of Pain Management Center,Shanghai Sixth People's Hospital,Shanghai City 200233,China)

机构地区：[1]上海市第六人民医院疼痛科,200233

出　　处：《中华疼痛学杂志》2021年第3期250-255,共6页Chinese Journal Of Painology

摘　　要：目的评价以膝关节内上、内下神经和隐神经髌下支为靶点行超声引导下神经脉冲射频治疗膝骨关节炎患者的临床效果。方法前瞻性随机对照研究收集2019年6月至2020年2月于上海市第六人民医院疼痛科门诊收治的膝骨关节炎患者64例,年龄≥60岁,性别不限,按照随机数字表法将其分为射频组(PRF组)和神经阻滞组(NB组),每组32例,分别实施超声引导下膝关节内上、内下神经和隐神经髌下支射频和神经阻滞。NB组每靶神经给予2%利多卡因2 ml,共6 ml。PRF组在对靶神经给予相同药物阻滞基础上进行脉冲射频,射频电极温度设置为42℃,每靶神经治疗时间120 s×3次,两组均为单次治疗。比较两组患者治疗前及治疗后2、4、12周时的视觉模拟评分(VAS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分和治疗有效率。结果两组患者一般资料比较,差异均无统计学意义(P均>0.05)。两组患者不同时点VAS评分差异有统计学意义(F=139.84,P<0.001),时间与分组间VAS评分存在交互作用(F=23.67,P<0.001)。两组患者不同时点WOMAC评分差异有统计学意义(F=1857.79,P<0.001),时间与分组间WOMAC评分存在交互作用(F=46.12,P<0.001)。治疗后2、4和12周时,PRF组治疗有效率均高于NB组(65.6%比31.3%,37.5%比3.1%,25%比0,P均<0.05)。结论以膝关节内上、内下神经和隐神经髌下支为靶点的超声引导下神经脉冲射频可有效缓解膝骨关节炎患者症状,安全性高,效果优于单纯神经阻滞。Objective To evaluate the efficacy of ultrasound-guided peri-genicular nerve pulsed radiofrequency in the treatment of patients with knee osteoarthritis.Methods Sixty-four patients,admitted to the Pain Department of the Sixth People's Hospital from June 2019 to February 2020,aged≥60 years old,both sexes,were included and randomly divided into pulsed radiofrequency group(group PRF)and never block group(group NB),32 cases in each group.In group NB,each target nerve was given 2 ml of 2%lidocaine,for a total of 6 ml.In group PRF,pulse radiofrequency was performed on the basis of giving the same anesthetics to the target nerves as in group NB.The temperature of the radiofrequency electrode was set to 42℃,and the treatment time of each target nerve was 120 seconds×3 times.All patients were received only one treatment.Visual analogue scale(VAS),Western Ontario and McMaster Universities osteoarthritis index(WOMAC)scores and effective rate were recorded and compared before the treatment,2,4 and 12 weeks after the treatment.Results No difference was found in general data between the two groups(all P>0.05).There were significant differences in VAS at different time points in the two groups(F=139.84,P<0.001);and there was an interaction between time and group in VAS(F=23.67,P<0.001).There were significant differences in WOMAC scores at different time points in the two groups(F=1857.79,P<0.001);and there was an interaction between time and group in WOMAC scores(F=23.67,P<0.001).The effective rate was higher at 2,4 and 12 weeks in group PRF than that in group NB respectively(65.6%vs.31.3%,37.5%vs.3.1%,25%vs.0,all P<0.05).Conclusion Ultrasound-guided peri-genicular nerve pulsed radiofrequency targeting the superior,inferior and inferior patellar branch of saphenous nerves can effectively and safely alleviate the symptoms in patients with knee osteoarthritis.Its effects are superior to the nerve block only.

关 键 词：骨关节炎 膝 超声检查 多普勒 脉冲 导管消融术 

分 类 号：R684.3[医药卫生—骨科学]