多模式膝神经射频消融术对比膝关节注射治疗顽固性膝骨关节炎的临床疗效及安全性分析  

Clinical efficacy and safety analysis of knee nerve multi-mode radiofrequency combined with knee joint injection in the treatment of refractory knee osteoarthritis

作　　者：苗羽[1] 林鹋 朱谦[1] 刘德胜 毛鹏[1] 司马蕾[1] 樊碧发[1] MIAO Yu;LIN Miao;ZHU Qian;LIU Desheng;MAO Peng;SIMA lei;FAN Bifa(Department of Pain Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pain Medicine,Fujian Provincial Hospital,Fuzhou 350000,China;Department of Anesthesiology,The Second Affiliated Hospital of Hainan Medical University,Haikou 570216,China)

机构地区：[1]中日友好医院疼痛科,北京100029 [2]福建省立医院疼痛科,福州350000 [3]海南医学院第二附属医院麻醉科,海口570216

出　　处：《中国疼痛医学杂志》2023年第12期923-933,共11页Chinese Journal of Pain Medicine

基　　金：中日友好医院高水平医院临床业务费专项临床研究项目(2022-NHLHCRF-YSPY-02);国家重点研发计划(2016-KJBYF-004);首都卫生发展科研专项项目(首发2022-1-4061)。

摘　　要：目的:回顾性分析普通射频联合低温等离子射频消融术与膝关节腔内注射羧甲基壳多糖(医用几丁糖)治疗顽固性膝骨关节炎(knee osteoarthritis,KOA)的临床疗效和安全性。方法:纳入2020年2月至2021年3月中日友好医院疼痛科收治的顽固性KOA病人66例,根据治疗方法不同分为手术组35例和注射组31例,分别在术前、术后第2周、1个月、3个月、6个月、12个月应用疼痛数字分级评分法(numerical rating scale,NRS)评分、西安大略和麦克马斯特大学(the Western Ontario and McMaster Universities,WOMAC)骨关节炎评分、药物使用率、手术相关并发症、病人的满意度进行随访评估以及统计学分析。结果:与术前相比,手术组疗效优于注射组,在术后2周、1个月、3个月、6个月、12个月手术组NRS评分和WOMAC评分、术后药物使用率均明显下降;两组术后均未观察到下肢麻木、下肢无力、感觉减退、感觉异常、神经痛等严重不良反应。术后12个月,手术组82.9%的病人对术后疗效满意,注射组38.7%的病人对术后疗效感到满意。结论:膝神经射频联合低温等离子射频消融术可以有效缓解膝关节疼痛,改善关节功能,且未发现严重不良反应,可以作为全膝关节置换术以外的顽固性KOA的替代治疗模式。Objective:This retrospective study compared the clinical efficacy and safety of knee nerve multimode radiofrequency vs knee joint injection medical chitosan in the treatment of refractory knee osteoarthritis(KOA).Methods:From February 2020 to March 202166 patients with refractory KOA who received treatment at the Pain Department of China-Japan Friendship Hospital were divided into the surgery group(n=35)and the injection group(n=31).The patients'numerical rating scale(NRS)scores,the Western Ontario and McMaster Universities(WOMAC)osteoarthritis index scores,the proportion of nonsteroidal antiinflammatory drugs(NSAIDs)and/or opioid drugs used,surgical related complications and patient satisfaction were evaluated and analyzed at the time of before surgery and 2 weeks,1,3,6 and 12 months after surgery.Results:Compared with pre-operation,the patients in surgical group had better efficacy than the injection group.The NRS scores and WOMAC scores,as well as the postoperative drug use rate,decreased significantly at the times of 2 weeks,1,3,6 and 12 months follow-up after surgery.No serious adverse reactions,such as lower limb numbness,lower limb weakness,hypoesthesia,paresthesia,and neuralgia,were observed after surgery.82.9%of the patients in surgery group,38.7%of the patients in injection group were satisfied with the post-operative results at the time of 12 months follow-up after surgery.Conclusion:The combination of knee nerve radiofrequency and low-temperature plasma radiofrequency ablation can effectively alleviate knee joint pain,improve joint function,and have no serious adverse reactions,which can be used as an alternative treatment mode for refractory KOA other than total knee arthroplasty.

关 键 词：顽固性KOA 射频热凝术 脉冲射频术 低温等离子射频消融术 羧甲基壳多糖 NRS评分 WOMAC骨关节炎评分 

分 类 号：R684.3[医药卫生—骨科学]