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选择性膝动脉栓塞治疗膝骨关节炎疼痛——一项叙述性综述

Selective Genicular Artery Embolization in the Management of Osteoarthritic Knee Pain-A Narrative Review.

作者信息

O'Brien Stephanie, Blakeney William G, Soares Julian

机构信息

Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia.

Department of Radiology, Royal Perth Hospital, Perth, WA 6000, Australia.

出版信息

J Clin Med. 2024 May 31;13(11):3256. doi: 10.3390/jcm13113256.

Abstract

Many people with pain from osteoarthritis (OA) of the knee are either not ready for surgery or may never be surgical candidates. Genicular artery embolization (GAE) is a new proposed management for those with pain despite maximum medical management. It has historically been used to manage recurrent spontaneous haemarthrosis following total knee replacement, but newer studies are showing a positive effect in managing pre-arthroplasty knee OA. The goal of this review is to summarise current and relevant literature from searches of computerised databases and relevant journals, and analyse their results. Studies included show that GAE has promising outcomes in managing mild to moderate OA knee pain in those who have exhausted at least 3 months of conservative therapy. Most studies show improvements in VAS pain and PROM scores (including KOOS, and/or WOMAC). Minimal adverse effects have been associated in up to two years of follow up, the majority of which are self-resolving. The article précises a concise general procedural technique for performing GAE, as well as comparing and contrasting different embolic agents that may be utilised. GAE shows promising outcomes in management of mild to moderate OA knee pain. In the future, there will need to be higher volume studies to determine effectiveness, suitable candidates, and other potential adverse effects.

摘要

许多患有膝关节骨关节炎(OA)疼痛的人要么还没准备好接受手术,要么可能永远都不是手术的合适人选。膝下动脉栓塞术(GAE)是一种针对那些尽管接受了最大程度的药物治疗仍有疼痛的患者提出的新治疗方法。它过去一直用于治疗全膝关节置换术后复发性自发性关节积血,但最新研究表明,它在治疗关节置换术前的膝关节OA方面有积极效果。这篇综述的目的是总结通过检索计算机化数据库和相关期刊获得的当前相关文献,并分析其结果。纳入的研究表明,对于那些已经接受了至少3个月保守治疗的患者,GAE在治疗轻至中度OA膝关节疼痛方面有良好的效果。大多数研究显示视觉模拟评分法(VAS)疼痛评分和患者报告结局测量(PROM)评分(包括膝关节损伤和骨关节炎疗效评分(KOOS)及/或西安大略和麦克马斯特大学骨关节炎指数(WOMAC))有所改善。在长达两年的随访中,与之相关的不良反应最小,其中大多数可自行缓解。本文详细介绍了一种简洁的GAE一般操作技术,以及比较和对比可能使用的不同栓塞剂。GAE在治疗轻至中度OA膝关节疼痛方面显示出良好的效果。未来,需要进行更多大规模研究,以确定其有效性、合适的人选以及其他潜在的不良反应。

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