Masala Salvatore, Fiori Roberto, Calabria Eros, Raguso Mario, de Vivo Dominique, Cuzzolino Alessandro, Simonetti Giovanni
Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome "Tor Vergata", Rome, Italy.
Int J Rheum Dis. 2017 Jan;20(1):46-52. doi: 10.1111/1756-185X.12414. Epub 2014 Jun 19.
The purpose of our study was to investigate the role of intra-articular pulse-dose radiofrequency in management of painful hallux valgus refractory to conservative therapies.
Between November 2010 and April 2012, 51 patients (15 male, 36 female) with a median age of 71.4 years were included in our clinical trial. Under fluoroscopic guidance we introduced a 22 gauge 10 cm length cannula by a percutaneous access in the first metatarsophalangeal joint and its tip was placed intra-articularly. After removing the spindle, a radiofrequency needle with a 5 mm active tip was introduced. The following parameters were used: 1200 pulses at high voltage (45 V) with 20 msec duration followed by 480 msec silent phases.
A great reduction in pain intensity was documented at 1 week, 1 month and 3 months after procedures. Pain intensity increased between 5 and 8 months after treatments, so we performed a second procedure in all patients between 7 months and 9 months since the first treatment. Also in this case we obtained a great reduction of pain intensity in the first 3 months after the procedure. Pain intensity returned at preprocedural values after 9 months after second procedure. No complications were observed.
Our experience shows pulse-dose radiofrequency is a safe, repeatable and effective technique for managing patients with symptomatic hallux valgus in the short and medium term. Pulse-dose radiofrequency may improve pain control and quality of life in patients with hallux valgus refractory to conservative therapies.
本研究旨在探讨关节内脉冲剂量射频在保守治疗无效的疼痛性拇外翻管理中的作用。
2010年11月至2012年4月，51例患者（15例男性，36例女性）纳入我们的临床试验，中位年龄为71.4岁。在透视引导下，经皮穿刺将一根22号、10厘米长的套管针插入第一跖趾关节，使其尖端置于关节内。移除针芯后，插入一根尖端活性长度为5毫米的射频针。使用以下参数：高压（45伏）下1200个脉冲，持续时间20毫秒，随后是480毫秒的间歇期。
术后1周、1个月和3个月时，疼痛强度显著降低。治疗后5至8个月疼痛强度增加，因此我们在首次治疗后7至9个月对所有患者进行了第二次手术。同样，在这种情况下，术后前3个月疼痛强度也大幅降低。第二次手术后9个月，疼痛强度恢复到术前水平。未观察到并发症。
我们的经验表明，脉冲剂量射频在短期和中期是一种安全、可重复且有效的技术，可用于治疗有症状的拇外翻患者。脉冲剂量射频可能改善保守治疗无效的拇外翻患者的疼痛控制和生活质量。
