J Back Musculoskelet Rehabil. 2024;37(1):241-248. doi: 10.3233/BMR-220400.
Monopolar radiofrequency ablation (MRFA) of the genicular nerves has been considered the main interventional treatment for chronic knee pain. However, the variable locations of these nerves could suggest that traditional MRFA of genicular nerves may be insufficient to cover the area needed to provide complete sensory denervation. For these reasons, some alternatives have been proposed to achieve an increase in the lesion area that offers better outcomes such a bipolar radiofrequency ablation (BRFA).
To describe the efficacy and safety of the bipolar radiofrequency ablation (BRFA) of the genicular nerves in the patients with chronic knee pain.
A retrospective study was conducted in the Pain Medicine Department. Institutional review board approval from the Hospital Ethical Committee and informed consent were obtained. We reviewed our database for BRFA of genicular nerves from January 2018 to December 2021 for patients with chronic knee pain. The cannulas were placed using ultrasound guidance (10 cm, 22-gauge and 10 mm active curved tip), and each pair of cannulas were subjected to BRFA for 90 seconds at 80∘C. Data analysis was conducted using T-test for paired variables (Visual analogue scale and EuroQol, an instrument intended to complement other forms of quality-of-life measures).
Twenty-five patients met inclusion criteria after excluding 7 based on the study design. The mean improvement of our patients according to the VAS was -3.98 (95%CI: -4.37 to -3.59) p< 0.0001 and EuroQol +0.416 (95%CI: 0.364 to 0.468) p< 0.0001. The mean duration of improvement was 8 (6-11) months after BRFA. There were no reported serious adverse events related to the procedure, only local pain for 24 to 48 hours in 3 patients.
We can conclude that BRFA reduces procedural pain and increases the treatment area, providing more complete sensory denervation and improved clinical outcomes.
单极射频消融术（MRFA）已被认为是治疗慢性膝关节疼痛的主要介入治疗方法。然而，这些神经的位置多变表明，传统的膝关节神经 MRFA 可能不足以覆盖提供完全感觉神经阻滞所需的区域。出于这些原因，已经提出了一些替代方法来增加病变面积，从而提供更好的结果，例如双极射频消融术（BRFA）。
描述双极射频消融术（BRFA）治疗慢性膝关节疼痛的疗效和安全性。
在疼痛医学科进行回顾性研究。获得医院伦理委员会的机构审查委员会批准和知情同意。我们回顾了 2018 年 1 月至 2021 年 12 月间因慢性膝关节疼痛接受 BRFA 的膝关节神经的患者数据库。使用超声引导放置套管（10cm，22 号，10mm 主动弯曲尖端），每对套管在 80°C 下进行 90 秒的 BRFA。使用配对变量的 T 检验进行数据分析（视觉模拟量表和 EuroQol，一种旨在补充其他形式的生活质量测量的工具）。
排除 7 例不符合研究设计的患者后，有 25 例患者符合纳入标准。根据 VAS，我们的患者平均改善为-3.98（95%CI：-4.37 至-3.59）p<0.0001，EuroQol+0.416（95%CI：0.364 至 0.468）p<0.0001。BRFA 后平均改善持续时间为 8（6-11）个月。没有报告与该程序相关的严重不良事件，只有 3 名患者在 24 至 48 小时内出现局部疼痛。
我们可以得出结论，BRFA 可减轻手术疼痛并增加治疗面积，提供更完全的感觉神经阻滞和改善临床结果。
