Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial
Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial
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DOI：
10.1016/j.pain.2010.09.029
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发表时间：
2011-03-01
期刊：
影响因子：
7.4
通讯作者：
Shin, Jin-Woo
中科院分区：
文献类型：
--
作者：
Choi, Woo-Jong;Hwang, Seung-Jun;Shin, Jin-Woo
膝关节的慢性骨关节炎（OA）疼痛通常不能用当前的非药物或药物治疗有效管理。放射性（RF）神经切断术是慢性疼痛的治疗选择。我们研究了RF神经切断术应用于关节神经分支（膝神经）是否能有效缓解慢性OA膝关节疼痛。该研究涉及38名老年患者，（a）严重膝关节OA疼痛持续3个月以上，（B）对诊断性膝神经阻滞有阳性反应，（c）对保守治疗无反应。患者被随机分配接受透视引导下经皮RF膝神经切开术（RF组; n = 19）或未进行有效神经切开术的相同手术（对照组; n = 19）。在基线和术后1周、4周和12周测量视觉模拟量表（VAS）、牛津膝关节评分和7分量表上的整体感知效果。VAS评分显示，RF组在4周（p <0.001）和12周（p <0.001）时的膝关节疼痛较对照组轻。牛津膝关节评分显示相似的结果（p <0.001）。在RF组中，10/17（59%）、11/17（65%）和10/17（59%）分别在第1、4和12周时实现了至少50%的膝关节疼痛缓解。随访期间，无患者报告术后不良事件。膝神经的RF神经切断术在老年慢性膝关节OA疼痛的子集中导致显著的疼痛减轻和功能改善，因此可能是此类病例的有效治疗。需要进一步的试验，更大的样本量和更长的随访时间。(C)2010年国际疼痛研究协会。由Elsevier B出版。V.保留所有权利。
Chronic osteoarthritis (OA) pain of the knee is often not effectively managed with current non-pharmacological or pharmacological treatments. Radiofrequency (RF) neurotomy is a therapeutic alternative for chronic pain. We investigated whether RF neurotomy applied to articular nerve branches (genicular nerves) was effective in relieving chronic OA knee joint pain. The study involved 38 elderly patients with (a) severe knee OA pain lasting more than 3 months, (b) positive response to a diagnostic genicular nerve block and (c) no response to conservative treatments. Patients were randomly assigned to receive percutaneous RF genicular neurotomy under fluoroscopic guidance (RF group; n = 19) or the same procedure without effective neurotomy (control group; n = 19). Visual analogue scale (VAS), Oxford knee scores, and global perceived effect on a 7-point scale were measured at baseline and at 1, 4, and 12 weeks post-procedure. VAS scores showed that the RF group had less knee joint pain at 4 (p < 0.001) and 12 (p < 0.001) weeks compared with the control group. Oxford knee scores showed similar findings (p < 0.001). In the RF group, 10/17 (59%), 11/17 (65%) and 10/17 (59%) achieved at least 50% knee pain relief at 1, 4, and 12 weeks, respectively. No patient reported a post-procedure adverse event during the follow-up period. RF neurotomy of genicular nerves leads to significant pain reduction and functional improvement in a subset of elderly chronic knee OA pain, and thus may be an effective treatment in such cases. Further trials with larger sample size and longer follow-up are warranted. (C) 2010 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved.