Wake Forest University School of Medicine Winston-Salem, NC.
Pain Physician. 2018 May;21(3):279-284.
Chronic hip joint pain is a common condition with an estimated prevalence of 7% in men and 10% in women, in a population sample aged over 45. Conservative treatment can include physical therapy, weight loss, a variety of pharmacologic agents ranging from nonsteroidal antiinflammatory drugs (NSAIDS) to opioids, and intraarticular injections with various substances. Definitive treatment of hip pain, however, has primarily centered on hip arthroplasty.
We describe a novel anterior approach to cooled radiofrequency (RF) hip denervation under combined ultrasound (US) and fluoroscopy guidance to avoid the neurovascular femoral bundle and reach proper landmarks.
Retrospective chart review of consecutive cases.
Interventional Pain Management urban private practice.
Data on 52 RF ablations of the hip in 23 patients were retrospectively collected. RF ablation was conducted with patient supine and under guidance of fluoroscopy and US. While fluoroscopy was used to place RF probes to appropriate landmarks, sole purpose of using US was to avoid femoral neurovascular bundle. Data were collected on needle placement, stimulation parameters, and short- and long-term complications.
A total of 62 patients underwent 2 diagnostic blocks. Fifty-two of them had greater than 50% relief and agreed to RF ablation. Until now, the ablation was conducted in 23 patients. There were no adverse events, except one case of neuritis. Expectedly, the needle approach to the lateral articular branches of the femoral nerve was easily achieved with more than a 1 cm passage distance from the femoral nerve in all 52 RF cases (median 2.5 range 1-3.5 cm). Placement of the second trocar to the incisura acetabuli was more challenging; in 21 RF cases the passing distance was less than 1 cm (range 0.5 to 1.9 cm, median 0.8). Motor stimulation (2 Hz) at less than 1 V was positive for the obturator nerve in 26 cases, which resulted in electrode repositioning more laterally (2-5 mm). Change in the pain scores was from the baseline 7.61 ± 1.2 to 2.25 ± 1.4 after the RF ablation (P < 0.01). The time interval of pain relief was much longer for RF ablation.
Limitations of this retrospective, observational study include lack of blinding and absence of a comparator group. We did not attempt to wean opioids in our patient population.
An anterior needle approach to the lateral articular branches of the femoral and obturator nerves, and subsequently RF denervation of these nerves, is a safe procedure when US needle guidance is combined with identification of landmarks using fluoroscopy.
Chronic hip pain, radiofrequency ablation, hip denervation.
慢性髋关节疼痛是一种常见病症，在 45 岁以上人群样本中，男性患病率估计为 7%，女性为 10%。保守治疗包括物理疗法、减肥、各种药物治疗，范围从非甾体抗炎药（NSAIDs）到阿片类药物，以及各种物质的关节内注射。然而，髋关节疼痛的明确治疗主要集中在髋关节置换术上。
我们描述了一种新的经前路冷却射频（RF）髋关节去神经支配技术，该技术在超声（US）和透视引导下结合使用，以避开神经血管股束并到达适当的标志。
回顾性连续病例图表审查。
介入疼痛管理城市私人诊所。
回顾性收集了 23 例患者的 52 例 RF 髋关节消融数据。患者仰卧位，在透视和 US 引导下进行 RF 消融。透视用于将 RF 探头放置到适当的标志，而使用 US 的唯一目的是避免股神经血管束。收集了针的放置、刺激参数以及短期和长期并发症的数据。
共有 62 例患者进行了 2 次诊断性阻滞。其中 52 例缓解率大于 50%，并同意接受 RF 消融。到目前为止，已经在 23 例患者中进行了消融。除 1 例神经炎外，没有发生不良事件。预计，在所有 52 例 RF 病例中，股神经外侧关节支的针道很容易达到，与股神经的距离超过 1 cm（中位数 2.5 范围 1-3.5 cm）。放置第二个套管到髋臼切迹更具挑战性；在 21 例 RF 病例中，通过距离小于 1 cm（范围 0.5 至 1.9 cm，中位数 0.8）。在 26 例病例中，以 2 Hz 的电刺激（2 Hz）小于 1 V 为阳性，导致电极更向外侧重新定位（2-5 mm）。在 RF 消融后，疼痛评分从基线的 7.61±1.2 降至 2.25±1.4（P<0.01）。RF 消融的疼痛缓解时间间隔要长得多。
这项回顾性、观察性研究的局限性包括缺乏盲法和缺乏对照组。我们没有试图在患者人群中减少阿片类药物的使用。
当 US 引导针与透视下识别标志相结合时，前路针接近股神经和闭孔神经的外侧关节支，并随后对这些神经进行射频去神经支配，是一种安全的操作。
慢性髋痛，射频消融，髋关节去神经支配。
