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经导管动脉栓塞治疗慢性膝关节疼痛的临床疗效:轻度至中度与重度膝关节骨关节炎。

Clinical Outcomes of Transcatheter Arterial Embolisation for Chronic Knee Pain: Mild-to-Moderate Versus Severe Knee Osteoarthritis.

机构信息

Department of Radiology, H Plus Yangji Hospital, 1636, Nambusunhwan-ro, Gwanakgu, Seoul, Republic of Korea.

Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea.

出版信息

Cardiovasc Intervent Radiol. 2019 Nov;42(11):1530-1536. doi: 10.1007/s00270-019-02289-4. Epub 2019 Jul 23.

Abstract

PURPOSE

This retrospective study was conducted to compare the clinical outcomes of transcatheter arterial embolisation for chronic knee pain in patients with mild-to-moderate versus severe knee osteoarthritis.

MATERIALS AND METHODS

This study included patients (n = 41) who were refractory to conservative treatments and who underwent transcatheter arterial embolisation using imipenem/cilastatin sodium between June 2017 and July 2018. A total of 71 knees, including 30 bilateral cases, were treated and categorised into two groups according to the Kellgren-Lawrence grade: mild-to-moderate osteoarthritis (n = 59, Kellgren-Lawrence grade 1-3) and severe osteoarthritis (n = 12, Kellgren-Lawrence grade 4). The clinical outcomes were measured by the visual analogue scale score.

RESULTS

There were no significant differences in age, body mass index or baseline visual analogue scale scores between the two groups. The mean visual analogue scale scores in the mild-to-moderate osteoarthritis group were significantly decreased at 1 day, 1 week, 1 month, 3 months, and 6-months (5.5 at baseline vs. 3.2, 3.1, 2.9, 2.2, and 1.9, after treatment; all P = .00). These improvements were maintained at a mean of 10 ± 3 months (range 6-19 months) post-treatment. The visual analogue scale scores were significantly decreased in the severe osteoarthritis group for 1 month post-treatment (6.3 at baseline vs. 4.1, 4.1, and 4.4 at 1 day, 1 week, and 1 month; all P < .01). However, a decrease in pain was not statistically significant from 3 to 6 months (5.4 and 5.9 at 3 months and 6 months, respectively).

CONCLUSION

Transcatheter arterial embolisation effectively relieved pain in patients with mild-to-moderate osteoarthritis. In patients with severe osteoarthritis, pain severity decreased for 1 month but gradually increased to the initial severity score within 3 months.

LEVEL OF EVIDENCE

4, Case series.

摘要

目的

本回顾性研究旨在比较中重度膝关节骨关节炎与重度膝关节骨关节炎患者慢性膝关节疼痛行介入性动脉栓塞治疗的临床效果。

材料与方法

本研究纳入了 2017 年 6 月至 2018 年 7 月期间因保守治疗无效而行介入性动脉栓塞治疗的患者(n=41)。共治疗了 71 个膝关节,其中 30 例为双侧,根据 Kellgren-Lawrence 分级将其分为两组:中重度骨关节炎(n=59,Kellgren-Lawrence 分级 1-3 级)和重度骨关节炎(n=12,Kellgren-Lawrence 分级 4 级)。采用视觉模拟评分法(VAS)评估临床疗效。

结果

两组患者的年龄、体重指数和基线 VAS 评分无显著差异。中重度骨关节炎组患者的 VAS 评分在治疗后 1 天、1 周、1 个月、3 个月和 6 个月均显著降低(基线时为 5.5,治疗后分别为 3.2、3.1、2.9、2.2 和 1.9,均 P=0.00)。这些改善在治疗后平均 10±3 个月(6-19 个月)时仍能维持。重度骨关节炎组患者的 VAS 评分在治疗后 1 个月时显著降低(基线时为 6.3,治疗后 1 天、1 周和 1 个月时分别为 4.1、4.1 和 4.4,均 P<.01)。然而,3 至 6 个月时疼痛缓解程度无统计学差异(分别为 5.4 和 5.9)。

结论

介入性动脉栓塞能有效缓解中重度骨关节炎患者的疼痛。对于重度骨关节炎患者,疼痛程度在治疗后 1 个月时降低,但在 3 个月内逐渐恢复到初始严重程度评分。

证据等级

4,病例系列研究。

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