Lee Doo-Hyung, Lee Michael Y, Kwack Kyu-Sung, Yoon Seung-Hyun
Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea Department of Physical Medicine and Rehabilitation (M.Y. Lee), University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC. Department of Radiology Department of Physical Medicine and rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea.
Medicine (Baltimore). 2017 Mar;96(12):e6374. doi: 10.1097/MD.0000000000006374.
Knee osteoarthritis (KOA) is a common disease in middle-aged and elderly people. Pain is the chief complaint of symptomatic KOA and a leading cause of chronic disability, which is most often found in medial knees. The aim of this study is to evaluate the efficacy of pain relief and functional improvement in KOA patients treated with ultrasound-guided adductor canal block (ACB).This is a 3-month retrospective case-controlled comparative study. Two hundred patients with anteromedial knee pain owing to KOA that was unresponsive to 3-month long conservative treatments. Ninety-two patients received ACB with 9 mL of 1% of lidocaine and 1 mL of 10 mg triamcinolone acetonide (ACB group), and 108 continued conservative treatments (control group). The main outcome measure was visual analog scale (VAS) of the average knee pain level for the past one week. Secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the timed up and go test, numbers of analgesic ingestion per day, and opioid consumption per day.During the 3-month follow-up, 86 patients in ACB group and 92 in control group were analyzed. There was no significant difference, with the exception of the duration of symptoms, between the 2 groups in age, sex, body mass index, and Kellgren-Lawrence grade. Repeated-measures analysis of variance and post hoc tests showed improvement of VAS (at month 1), WOMAC (at month 1), and opioid consumption per day (at month 1 and 2) in ACB group. No adverse events were reported.To our knowledge, this is the first study to assess the efficacy of ACB for patients with KOA. ACB is an effective and safe treatment and can be an option for patients who are either unresponsive or unable to take analgesics.
膝骨关节炎（KOA）是中老年人的常见疾病。疼痛是有症状的KOA的主要主诉，也是导致慢性残疾的主要原因，最常出现在膝关节内侧。本研究的目的是评估超声引导下收肌管阻滞（ACB）治疗KOA患者时缓解疼痛和改善功能的疗效。
这是一项为期3个月的回顾性病例对照比较研究。200例因KOA导致膝关节前内侧疼痛且对为期3个月的保守治疗无反应的患者。92例患者接受了9毫升1%利多卡因和1毫升10毫克曲安奈德的ACB治疗（ACB组），108例继续接受保守治疗（对照组）。主要观察指标是过去一周膝关节平均疼痛水平的视觉模拟量表（VAS）。次要观察指标包括西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、计时起立行走测试、每日镇痛药摄入量和每日阿片类药物消耗量。
在3个月的随访期间，分析了ACB组的86例患者和对照组的92例患者。两组在年龄、性别、体重指数和凯尔格伦-劳伦斯分级方面，除症状持续时间外，无显著差异。重复测量方差分析和事后检验显示，ACB组的VAS（第1个月）、WOMAC（第1个月）和每日阿片类药物消耗量（第1个月和第2个月）有所改善。未报告不良事件。
据我们所知，这是第一项评估ACB对KOA患者疗效的研究。ACB是一种有效且安全的治疗方法，对于那些对镇痛药无反应或无法服用镇痛药的患者而言是一种选择。
