Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, California.
Department of Anesthesiology.
Pain Med. 2017 Sep 1;18(9):1631-1641. doi: 10.1093/pm/pnx069.
Determine outcomes of cooled radiofrequency ablation (C-RFA) of the genicular nerves for treatment of chronic knee pain due to osteoarthritis (OA).
Cross-sectional survey.
Academic pain medicine center.
Consecutive patients with knee OA and 50% or greater pain relief following genicular nerve blocks who underwent genicular nerve C-RFA.
Survey administration six or more months after C-RFA. Pain numeric rating scale (NRS), Medication Quantification Scale III (MQSIII), Patient Global Impression of Change (PGIC), and total knee arthroplasty (TKA) data were collected. Logistic regression was used to identify factors that predicted treatment success.
Thirty-three patients (52 discrete knees) met inclusion criteria. Thirty-five percent (95% confidence interval [CI] = 22-48) of procedures resulted in the combined outcome of 50% or greater reduction in NRS score, reduction of 3.4 or more points in MQSIII score, and PGIC score consistent with "very much improved/improved." Nineteen percent (95% CI = 10-33) of procedures resulted in complete pain relief. Greater duration of pain and greater than 80% pain relief from diagnostic blocks were identified as predictors of treatment success. The accuracy of the model was 0.88 (95% CI = 0.78-0.97, P < 0.001).
Genicular C-RFA demonstrated a success rate of 35% based on a robust combination of outcome measures, and 19% of procedures resulted in complete relief of pain at a minimum of six months of follow-up. Report of 80% or greater relief from diagnostic blocks and duration of pain of less than five years are associated with high accuracy in predicting treatment success. Further prospective study is needed to optimize the patient selection protocol and success rate of this procedure.
确定冷却射频消融（C-RFA）治疗膝骨关节炎（OA）慢性膝关节疼痛的治疗效果。
横断面调查。
学术疼痛医学中心。
接受膝关节 C-RFA 治疗的膝关节 OA 患者，在接受膝关节神经阻滞治疗后疼痛缓解 50%或以上，且至少有 50%的缓解率。
在 C-RFA 后 6 个月或以上进行问卷调查。收集疼痛数字评分量表（NRS）、药物量化量表 III（MQSIII）、患者总体印象变化（PGIC）和全膝关节置换术（TKA）数据。采用逻辑回归分析来确定预测治疗成功的因素。
33 名患者（52 个膝关节）符合纳入标准。35%（95%置信区间[CI] = 22-48）的手术结果为 NRS 评分降低 50%或以上、MQSIII 评分降低 3.4 或更多分、PGIC 评分与“非常改善/改善”一致的综合结果。19%（95% CI = 10-33）的手术结果为完全疼痛缓解。诊断性阻滞中疼痛持续时间较长和疼痛缓解率大于 80%被确定为治疗成功的预测因素。该模型的准确性为 0.88（95% CI = 0.78-0.97，P < 0.001）。
基于一系列综合疗效指标，C-RFA 治疗膝骨关节炎的成功率为 35%，19%的手术在至少 6 个月的随访中完全缓解疼痛。诊断性阻滞缓解率达到 80%或更高、疼痛持续时间不到 5 年与预测治疗成功的准确性较高相关。需要进一步的前瞻性研究来优化该手术的患者选择方案和成功率。
