Holy Cross Hospital, Fort Lauderdale, FL, USA.
Neuromodulation. 2010 Apr;13(2):131-6. doi: 10.1111/j.1525-1403.2009.00255.x. Epub 2009 Nov 20.
The objective of this study is to present a novel approach for the treatment of severe, chronic knee joint pain following total knee arthroplasty utilizing peripheral subcutaneous field stimulation and discuss the role of this treatment modality in patients with symptoms that are refractory to conventional pharmacologic, surgical, and physical therapies.
Presented are two case reports of patients with chronic intractable knee pain where peripheral nerve stimulation via a permanent neurostimulating implant was introduced successfully. Both patients presented with persistent knee pain, for greater than one year, after having had total knee arthroplasty. The patients' symptoms failed to be alleviated by a variety of interventions including non-steroidal anti-inflammatory drugs (NSAIDS), oral antidepressants, membrane stabilizers, opioids, physical therapy, surgical revisions, manipulation under anesthesia, local anesthetic patches, and transcutaneous electrical nerve stimulation. In each case, direct stimulation of the knee was achieved utilizing a peripheral nerve stimulator via a periarticular approach.
Neuromodulation daily has produced both significant pain relief and functional improvement. Significant decreases in pain visual analog scale (VAS) scores and improvement in functional capacity were observed during the stimulation trial and during the follow-up after permanent implantation. The mean VAS score changed dramatically.
Introduction of a peripheral subcutaneous field stimulation directly to the painful knee area is a novel and simple procedure that was extremely effective for the relief of pain and may provide a breakthrough in the treatment of chronic intractable knee pain following total knee arthroplasty. The periarticular approach has several advantages, including only small incisions over the lateral and medial knee, proximal thigh and abdomen resulting in minimal strain on the lead array with flexion and extension contributing to overall stability of this system.
本研究旨在介绍一种利用外周皮下场刺激治疗全膝关节置换术后严重慢性膝关节疼痛的新方法，并讨论该治疗方法在对常规药物、手术和物理治疗无效的患者中的作用。
介绍了两例慢性顽固性膝关节疼痛患者，通过永久性神经刺激植入物成功引入外周神经刺激。两名患者均在全膝关节置换术后一年以上出现持续性膝关节疼痛。患者的症状通过各种干预措施均未得到缓解，包括非甾体抗炎药（NSAIDs）、口服抗抑郁药、膜稳定剂、阿片类药物、物理治疗、手术翻修、麻醉下手法、局部麻醉贴剂和经皮电神经刺激。在每种情况下，通过关节周围途径利用外周神经刺激器直接刺激膝关节。
神经调节每天都能显著缓解疼痛和改善功能。在刺激试验期间和永久性植入后的随访期间，观察到疼痛视觉模拟量表（VAS）评分显著降低和功能能力改善。
将外周皮下场刺激直接引入疼痛的膝关节区域是一种新颖且简单的程序，对于缓解疼痛非常有效，可能为全膝关节置换术后慢性顽固性膝关节疼痛的治疗提供突破。关节周围入路有几个优点，包括在膝关节外侧和内侧、大腿近端和腹部仅做小切口，导致在屈伸时对导联阵列的压力最小，从而提高了系统的整体稳定性。
