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膝动脉栓塞术:一种治疗难治性骨关节炎相关膝关节疼痛的新方法。

Genicular Artery Embolization: A New Tool for the Management of Refractory Osteoarthritis-Related Knee Pain.

作者信息

Femia Marco, Valenti Pittino Carlo, Fumarola Enrico Maria, Tramarin Marco, Papa Maurizio, Giurazza Francesco, Francioso Antonio Pio, Fior Davide, Moramarco Lorenzo Paolo, Antonini Guido, Vercelli Ruggero, Cariati Maurizio

机构信息

Interventional Radiology Unit, ASST Santi Paolo Carlo, 20122 Milan, Italy.

Complex Unit of Radiology, Department of Diagnostic, ASST Lodi, 26900 Lodi, Italy.

出版信息

J Pers Med. 2024 Jun 26;14(7):686. doi: 10.3390/jpm14070686.

DOI:10.3390/jpm14070686
PMID:39063940
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11278466/
Abstract

Osteoarthritis (OA) of the knee is a prevalent cause of chronic pain and disability, particularly affecting women. While traditionally attributed to chronic wear and tear, recent evidence highlights multifactorial pathogenesis involving low-grade inflammation and neoangiogenesis. Current therapeutic options include physical therapy, pharmacotherapy, and total knee arthroplasty (TKA). However, a subset of patients remain symptomatic despite conservative measures, necessitating the development of minimally invasive interventions. Genicular artery embolization (GAE) emerges as a promising option, targeting neovascularization and inflammatory processes in OA. This paper reviews the pathophysiological basis, patient selection criteria, procedural details, and outcomes of GAE. Notably, GAE demonstrates efficacy in relieving knee pain and improving function in patients refractory to conventional therapy. While further research is warranted to elucidate its long-term outcomes and compare it with existing modalities, GAE represents a novel approach in the management of symptomatic knee OA, potentially delaying or obviating the need for surgical intervention. Here, we synthesize the relevant literature, technical details of the procedure, and future perspectives. Moreover, the success of GAE prompts the exploration of transarterial embolization in other musculoskeletal conditions, underscoring the evolving role of interventional radiology in personalized pain management strategies.

摘要

膝关节骨关节炎(OA)是慢性疼痛和残疾的常见原因,对女性影响尤甚。传统上认为其由慢性磨损所致,但近期证据表明其发病机制是多因素的,涉及低度炎症和新生血管形成。目前的治疗选择包括物理治疗、药物治疗和全膝关节置换术(TKA)。然而,尽管采取了保守措施,仍有一部分患者症状持续存在,因此需要开发微创干预手段。膝动脉栓塞术(GAE)作为一种有前景的选择应运而生,其针对OA中的新生血管形成和炎症过程。本文综述了GAE的病理生理基础、患者选择标准、操作细节及治疗效果。值得注意的是,GAE在缓解常规治疗难治性患者的膝关节疼痛及改善功能方面显示出疗效。虽然仍需进一步研究以阐明其长期疗效并与现有治疗方式进行比较,但GAE代表了一种治疗有症状膝关节OA的新方法,有可能延迟或避免手术干预的需要。在此,我们综合了相关文献、该操作的技术细节及未来展望。此外,GAE的成功促使人们探索在其他肌肉骨骼疾病中进行经动脉栓塞治疗,凸显了介入放射学在个性化疼痛管理策略中不断演变的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9860/11278466/d3fd9356ff6d/jpm-14-00686-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9860/11278466/fe2ad9326a19/jpm-14-00686-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9860/11278466/139c04e06b25/jpm-14-00686-g002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9860/11278466/d3fd9356ff6d/jpm-14-00686-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9860/11278466/fe2ad9326a19/jpm-14-00686-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9860/11278466/139c04e06b25/jpm-14-00686-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9860/11278466/09b3c9514d9a/jpm-14-00686-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9860/11278466/6ea680d6415a/jpm-14-00686-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9860/11278466/d3fd9356ff6d/jpm-14-00686-g005.jpg

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Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021.
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Lancet Rheumatol. 2023 Aug 21;5(9):e508-e522. doi: 10.1016/S2665-9913(23)00163-7. eCollection 2023 Sep.
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