Rush Sports Medicine Fellowship Program, Midwest Orthopedics at Rush Sports Medicine, Chicago, Illinois, USA.
Arthroscopy. 2013 Feb;29(2):336-42. doi: 10.1016/j.arthro.2012.10.001. Epub 2013 Jan 3.
The purpose of this study was to determine operating parameters for joint fluid lavage using radiofrequency (RF) in maintaining intra-articular temperatures ≤50°C in the hip joint and to then quantify the influence of flow rate on maintaining safe intra-articular temperatures.
Fiberoptic intra-articular thermometers at radial distance intervals of 1, 2, 5, and 10 mm, spanning cross-sectional areas of 3.14, 12.56, 78.5, and 314.1 mm(2), respectively, from the RF probe were used in 3 human hip cadaveric specimens at room temperature, with 9 trials per variable, using a 3-portal technique with a capsule release. Using a new Dyonics RF System continuously at the superior capsulolabral junction for 90 seconds, continuous temperatures were recorded at 50 mm Hg inflow and variable outflow intervals: no flow and 5, 15, and 30 seconds. Lavages were 1 second in duration on suction. Statistical comparison was through multivariate regression analysis and a logistic model.
Temperatures reached ≥50°C at 5-mm radial distance from the probe in all but the 5-second pulse lavage group. Elevated temperatures were reached within 1 to 2 seconds locally (1- to 2-mm radial distance) and at a radial distance of 5 mm in the 15-, 30-, and 0-second lavage groups. Logistic regression revealed a reduction in the odds that temperatures ≥50°C will occur as flow frequency increases every 30 (odds ratio = 0.68, P = .086); 15 (odds ratio = -1.22, P = .0067); and 5 (odds ratio = -4.26, P < .0001) seconds.
Increasing-interval pulsed irrigation is effective in maintaining intra-articular temperature profiles below 50°C during use of continuous RF ablation. Five-second-interval pulsed lavage is the longest flow interval identified during which fluid 5 mm radially from the RF device never reached temperatures >50°C.
Clinical guidelines for using the RF ablation include: meticulous technique, intermittent use, good inflow and outflow, and pulsed lavage at frequent intervals.
本研究旨在确定射频 (RF) 关节冲洗的操作参数，以维持髋关节内关节温度≤50°C，并定量评估流量对维持安全关节内温度的影响。
在室温下，使用光纤关节内温度计，以 1、2、5 和 10mm 的径向距离间隔，分别测量从 RF 探头的横截面积为 3.14、12.56、78.5 和 314.1mm2 的区域，在 3 个人体髋关节尸体标本中，使用 3 个端口技术进行囊释放。使用新的 Dyonics RF 系统在肩袖上连续 90 秒，在 50mmHg 流入和可变流出间隔下连续记录温度：无流和 5、15 和 30 秒。冲洗持续 1 秒，持续抽吸。通过多元回归分析和逻辑模型进行统计比较。
除了 5 秒脉冲冲洗组外，在距离探头 5mm 的所有部位都达到了≥50°C 的温度。局部温度（1-2mm 径向距离）在 1-2 秒内升高，在 15、30 和 0 秒冲洗组中，在 5mm 径向距离处达到了升高的温度。逻辑回归显示，随着每 30 秒（比值比=0.68，P=0.086）、15 秒（比值比=-1.22，P=0.0067）和 5 秒（比值比=-4.26，P<0.0001）的流量增加，出现≥50°C 温度的可能性降低。
在使用连续 RF 消融时，增加间隔脉冲冲洗可有效维持关节内温度低于 50°C。5 秒间隔脉冲冲洗是确定的最长流动间隔，在此期间，距 RF 设备 5mm 处的流体从未达到>50°C 的温度。
使用 RF 消融的临床指南包括：精细的技术、间歇性使用、良好的流入和流出以及频繁间隔的脉冲冲洗。
