使用三叉电极进行扩展神经捕捉的膝状神经射频消融治疗慢性膝关节疼痛的长期临床结果。
Long-term clinical outcomes of genicular nerve radiofrequency ablation for chronic knee pain using a three-tined electrode for expanded nerve capture.
作者信息
Koshi Edvin, Meiling James B, Conger Aaron M, McCormick Zachary L, Burnham Taylor R
机构信息
Department of Physical Medicine and Rehabilitation, Dalhousie University, 650 Washmill Lake Drive, Suite 250, Halifax, Nova Scotia, B3S 0H8, Canada.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
出版信息
Interv Pain Med. 2021 Nov 19;1(1):100003. doi: 10.1016/j.inpm.2021.100003. eCollection 2022 Mar.
OBJECTIVE
Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment option for chronic knee pain in native knee osteoarthritis and total knee arthroplasty (TKA) patients. Recent dissections have revealed significant variability in typical genicular nerve targets and other sensory nerves not included in previous studies. Early, short-term results suggest that more complete sensory denervation with GNRFA may result in more significant pain reduction; however, no long-term clinical outcome exists. We aim to present long-term clinical outcomes after an expanded GNRFA technique with a three-tined radiofrequency cannula.
METHODS
Eleven consecutive patients with ≥6 months of knee pain underwent an expanded GNRFA protocol targeting the superomedial (SMGN), superolateral (SLGN), inferomedial genicular nerves (IMGN), in addition to the nerves to vastus medialis (NVM), lateralis (NVL), and intermedius (NVI). Long-term pain and impression of change outcomes were collected in a cross-sectional fashion.
RESULTS
At ≥18 months (mean 24 months) post-GNRFA, 91% (95% CI = 59, 100%), 73% (95% CI = 46, 99%), and 9% (95% CI = 0, 26%) of patients reported ≥50%, ≥80%, and 100% pain relief, respectively. Additionally, 27% (95% CI = 1, 54%) and 64% (95% CI = 35, 92%) of individuals reported a PGIC score of 6 ("much improved") and 7 ("very much improved"), respectively. The proportion of individuals who reported the MCID for the PGIC (score of ≥6) was 91% (95% CI = 59, 100%). There were no adverse events reported amongst the patients in this cohort. No patients progressed to surgery.
CONCLUSION
This single-arm cohort suggests that an expanded GNRFA protocol targeting SMGN, SLGN, IMGN, NVM, NVL, and NVI nerves with a three-tined electrode, resulted in significant long-term (≥18 months) improvements in pain and patient-perceived global improvement. Large, head-to-head trials are needed to establish whether this GNRFA protocol is superior to those used in previous clinical studies and those currently used more commonly in practice.
目的
膝神经射频消融术（GNRFA）是治疗原发性膝关节骨关节炎和全膝关节置换术（TKA）患者慢性膝关节疼痛的一种有效治疗选择。最近的解剖研究显示，典型的膝神经靶点以及先前研究未涵盖的其他感觉神经存在显著变异。早期的短期结果表明，GNRFA实现更完全的感觉神经去神经支配可能会带来更显著的疼痛减轻；然而，尚无长期临床结果。我们旨在展示使用三尖射频套管针的扩展GNRFA技术后的长期临床结果。
方法
11例膝关节疼痛≥6个月的连续患者接受了扩展GNRFA方案，该方案除了针对股内侧肌神经（NVM）、股外侧肌神经（NVL）和股中间肌神经（NVI）外，还针对膝上内侧神经（SMGN）、膝上外侧神经（SLGN）、膝下内侧神经（IMGN）。以横断面方式收集长期疼痛和变化印象结果。
结果
在GNRFA术后≥18个月（平均24个月）时，分别有91%（95%CI = 59, 100%）、73%（95%CI = 46, 99%）和9%（95%CI = 0, 26%）的患者报告疼痛缓解≥50%、≥80%和100%。此外，分别有27%（95%CI = 1, 54%）和64%（95%CI = 35, 92%）的个体报告PGIC评分为6（“改善很多”）和7（“改善非常多”）。报告PGIC达到最小临床重要差异（评分≥6）的个体比例为91%（95%CI = 59, 100%）。该队列患者中未报告不良事件。没有患者进展到需要手术的程度。
结论
这个单臂队列研究表明，使用三尖电极针对SMGN、SLGN、IMGN、NVM、NVL和NVI神经的扩展GNRFA方案，在长期（≥18个月）内可显著改善疼痛和患者自我感觉整体改善情况。需要进行大规模的直接比较试验，以确定这种GNRFA方案是否优于先前临床研究中使用的方案以及目前临床实践中更常用的方案。
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