Carlone Andrew G, Grothaus Olivia, Jacobs Cale, Duncan Stephen T
Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA.
Arthroplast Today. 2021 Feb 8;7:220-224. doi: 10.1016/j.artd.2020.12.003. eCollection 2021 Feb.
The purpose of this study was to determine demographic and psychosocial factors that influence the effectiveness of cooled radiofrequency genicular nerve ablation (C-RFA) and block in patients with chronic knee pain secondary to osteoarthritis (OA).
A retrospective review was completed including patients with knee OA who underwent genicular nerve ablation or block or both. Patient information collected included opioid use, psychological comorbidities, smoking history, body mass index, and medical comorbidities. Success was defined using the Osteoarthritis Research Society International criterion of greater than or equal to 50% reported pain relief from the procedure. Patients without a diagnosis of knee OA and patients with ipsilateral total knee arthroplasty were excluded. Patient factors were compared between (1) those that did or did not respond to the initial block and (2) those that did or did not respond to C-RFA.
Of the 176 subjects that underwent genicular nerve block, 31.8% failed to respond to the procedure. Subjects that failed the initial block were significantly more likely to have psychological comorbidities, smoking history, and diabetes. Of the subjects that proceeded to genicular nerve ablation, 53.7% reported less than 50% pain relief, and 46.3% reported pain relief greater than or equal to 50% at the first follow-up visit. While the presence of psychological comorbidities, smoking, and diabetes were associated with first-stage block failures, these patient factors were not associated with second-stage ablation failures.
C-RFA may be an effective adjunct therapy as part of a multimodal pain regimen; however, individual patient characteristics must be considered.
本研究的目的是确定影响冷却射频膝神经消融术（C-RFA）和阻滞对骨关节炎（OA）继发慢性膝关节疼痛患者疗效的人口统计学和社会心理因素。
完成一项回顾性研究，纳入接受膝神经消融或阻滞或两者皆有的膝骨关节炎患者。收集的患者信息包括阿片类药物使用情况、心理合并症、吸烟史、体重指数和医疗合并症。成功的定义采用国际骨关节炎研究学会的标准，即术后报告疼痛缓解大于或等于50%。排除未诊断为膝骨关节炎的患者和同侧全膝关节置换术患者。比较患者因素：（1）对初始阻滞有反应或无反应的患者；（2）对C-RFA有反应或无反应的患者。
在176例接受膝神经阻滞的受试者中，31.8%对该手术无反应。初始阻滞失败的受试者更有可能患有心理合并症、吸烟史和糖尿病。在接受膝神经消融的受试者中，53.7%报告疼痛缓解小于50%，46.3%在首次随访时报告疼痛缓解大于或等于50%。虽然心理合并症、吸烟和糖尿病与第一阶段阻滞失败有关，但这些患者因素与第二阶段消融失败无关。
C-RFA作为多模式疼痛治疗方案的一部分可能是一种有效的辅助治疗方法；然而，必须考虑个体患者特征。
