Diep Dion, Mittal Nimish, Sangha Harpreet, Farag Jordan
Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
Interv Pain Med. 2023 Mar 30;2(2):100247. doi: 10.1016/j.inpm.2023.100247. eCollection 2023 Jun.
Cryoneurolysis involves percutaneous insertion of a cryoprobe induced to extremely cold temperatures to disrupt peripheral nerve conduction. The primary objective of this scoping review is to summarize and critically appraise the current evidence for the benefits and safety of cryoneurolysis for non-cancer knee pain. The secondary objective is to describe the variations in cryoneurolysis techniques used.
MEDLINE, EMBASE, PubMed, Cochrane Library, and Web of Science were searched from their inception to February 2023 for any primary literature investigating the use of cryoneurolysis for non-cancer-related knee pain. Data was extracted for study characteristics, intervention characteristics, and clinical outcomes.
Fourteen studies were identified, including three randomized controlled trials, four retrospective cohort studies, and seven case studies/series. Two studies included knee osteoarthritis patients, three studies included non-specific chronic knee pain patients; and nine studies included pre- or post-total knee arthroplasty patients. Ten studies targeted the infrapatellar branch of the saphenous nerve while the remaining four studies did not report the nerve targeted. Studies consistently demonstrated improvements in pain, function, quality of life, and opioid consumption. Most adverse events were mild and self-limiting. Considerable variations in technique parameters were observed.
Cryoneurolysis is a promising intervention to improve outcomes in non-cancer knee pain populations, particularly in mild-to-moderate knee osteoarthritis and pre-total knee arthroplasty populations. However, cryoneurolysis for knee pain remains largely investigational as more high-quality randomized controlled trials are required to further elucidate efficacy as well as optimal nerve selection and technique.
冷冻神经lysis术涉及经皮插入冷冻探头，使其达到极低温度以破坏周围神经传导。本范围综述的主要目的是总结并批判性评价目前关于冷冻神经lysis术治疗非癌性膝关节疼痛的益处和安全性的证据。次要目的是描述所使用的冷冻神经lysis术技术的差异。
检索MEDLINE、EMBASE、PubMed、Cochrane图书馆和Web of Science，检索时间从各数据库建库至2023年2月，以查找任何研究冷冻神经lysis术用于非癌性膝关节疼痛的原始文献。提取有关研究特征、干预特征和临床结果的数据。
共纳入14项研究，包括3项随机对照试验、4项回顾性队列研究和7项病例研究/系列。2项研究纳入膝关节骨关节炎患者，3项研究纳入非特异性慢性膝关节疼痛患者；9项研究纳入全膝关节置换术前或术后患者。10项研究针对隐神经髌下支，其余4项研究未报告所针对的神经。研究一致表明在疼痛、功能、生活质量和阿片类药物使用方面有改善。大多数不良事件为轻度且自限性。观察到技术参数存在相当大的差异。
冷冻神经lysis术是一种有前景的干预措施，可改善非癌性膝关节疼痛人群的治疗效果，尤其是在轻度至中度膝关节骨关节炎和全膝关节置换术前人群中。然而，冷冻神经lysis术治疗膝关节疼痛在很大程度上仍处于研究阶段，因为需要更多高质量的随机对照试验来进一步阐明其疗效以及最佳神经选择和技术。
