Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
Department of Anatomy, Korea University College of Medicine, Seoul, Republic of Korea.
Knee. 2020 Oct;27(5):1577-1584. doi: 10.1016/j.knee.2020.08.006. Epub 2020 Sep 2.
Radiofrequency ablation (RFA) of the articular branches innervating the anterior knee capsule has been studied as a possible alternative to surgery for degenerative arthritis. However, the neurovascular topography of the anterior knee capsule remains unclear.
One leg from each of the 20 formalin-embalmed cadaveric specimens was investigated. Modified ablation points (MAPs) were evaluated for a possible alternative for conventional target points (CAPs).
For the nerve to vastus medialis (NVM), the probability of identifying the nerve was higher at MAP compared with CAP (62.5% vs. 25%). The mean shortest distance from the nerve was shorter at MAP compared with CAP (18.0 mm vs. 29.9 mm). The probabilities and distances for other nerves were not significantly different between the points. However, the probability of identifying the artery was significantly lower at MAPs compared with CAPs for arteries (0%, 5.3%, and 0% vs. 84.2%, 84.2%, and 73.3% for superior medial genicular, superior lateral genicular, and inferior medial genicular artery, respectively). For the recurrent peroneal nerve (RPN), a new target point was set in MAPs.
The current landmark for genicular nerve procedures may not accurately target the correct nerve position, or reduce the risk for vessel damage. A more proximal target may reduce complications and increase the probability of successful procedures, although clinical correlation is needed.
关节支射频消融（RFA）已被研究作为治疗退行性关节炎的手术替代方法。然而，前膝关节囊的神经血管分布仍不清楚。
研究了 20 具福尔马林固定的尸体标本的每只腿。评估了改良消融点（MAP）作为传统靶点（CAP）的替代点的可能性。
对于股内侧肌神经（NVM），在 MAP 处识别神经的概率高于 CAP（62.5%比 25%）。MAP 处神经的最短距离平均比 CAP 处更短（18.0 毫米比 29.9 毫米）。其他神经的概率和距离在两个点之间没有显著差异。然而，MAP 处识别动脉的概率明显低于 CAP 处，对于内侧上髁动脉、外侧上髁动脉和内侧下髁动脉，分别为 0%、5.3%和 0%，84.2%、84.2%和 73.3%。对于腓总返神经（RPN），在 MAP 中设定了一个新的靶点。
目前的关节支神经手术的标志可能无法准确地定位到正确的神经位置，或降低血管损伤的风险。更靠近近端的靶点可能会减少并发症，增加手术成功的概率，尽管需要临床相关性。
