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关节内神经靶向冷却脉冲射频消融治疗膝骨关节炎疼痛的镇痛效果:系统评价和荟萃分析。

The Analgesic Effectiveness of Genicular Nerve-targeted Cooled and Pulsed Radiofrequency Ablation for Osteoarthritis Knee Pain: A Systematic Review and Meta-analysis.

机构信息

Department of Orthopaedic and Traumatology, Sebelas Maret University, Surakarta, Indonesia; Department of Orthopaedic and Traumatology, Dr. Moewardi General Hospital Surakarta, Indonesia.

Department of Orthopaedic and Traumatology, Sebelas Maret University, Surakarta, Indonesia.

出版信息

Pain Physician. 2024 Sep;27(7):357-373.


DOI:
PMID:39353105
Abstract

BACKGROUND: Radiofrequency ablation (RFA) is a form of therapy for knee osteoarthritis (OA) pain that has become more popular in recent years. In addition to standard RF approaches, there are cooled and pulsed options. RFA could be used to treat the superolateral, superomedial, and inferomedial branches of the genicular nerves. Pulsed and cooled RF ablation on the genicular nerve to treat knee OA pain, however, has not yet been shown to be effective. OBJECTIVES: We conducted a meta-analysis to assess nonconventional, pulsed or cooled, RFA on the genicular nerve to treat knee OA pain; intended our study to provide useful information in deciding whether to use nonconventional RFA because of its effectiveness. STUDY DESIGN: Meta-analysis study of nonconventional, pulsed or cooled, RFA on the genicular nerve to treat knee OA pain. METHODS: PubMed, Ovid MEDLINE, Scopus, and Cochrane Central were searched for eligible papers. In our literature review, procedures, posttreatment outcomes, follow-up data, and adverse events were compiled and analyzed from the selected studies. The National Heart, Lung, and Blood Institute Quality Assessment tool was used to assess therapeutic relevance and evidence strength. Our meta-analysis analyzed pre- and posttreatment pain and physical function scores. The primary outcome was pain measured with either the Visual Analog Scale  or the Numeric Rating Scale. The secondary outcome was physical function measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. RESULTS: Our systematic review and meta-analysis includes 11 eligible publications (604 patients). Both cooled and pulsed RFA procedures targeting the genicular nerve resulted in considerable pain reduction at post one, 3, 6, and 12 months (P < 0.005). There was no significant improvement in physical function outcome for the cooled RFA technique in all follow-up visits. There was a significant improvement in physical function outcome for the pulsed RFA technique at the one-month and 3-month follow-up visits. LIMITATIONS: Limitations include that there are a limited number of randomized controlled trials available, the methodology utilized for comparison is based on the change in outcome between baseline and follow-up visits. There are only a few papers that have reported physical function outcomes in complete WOMAC rating data. CONCLUSION: At the 6-month follow-up, both cooled and pulsed RFA targeting the genicular nerve provided significant osteoarthritic pain alleviation. There is no different in pain relief between cooled and pulsed RFA targeting the genicular nerve for treating knee osteoarthritis. There was no significant functional improvement of cooled RFA in all follow-ups, but there was a significant functional improvement of pulsed RFA up to 3-month follow-up. According to our study, knee osteoarthritis pain can be efficiently treated with pulsed and cooled radiofrequency with few adverse effects.

摘要

背景:射频消融 (RFA) 是一种治疗膝关节骨关节炎 (OA) 疼痛的方法,近年来越来越受欢迎。除了标准的 RF 方法外,还有冷却和脉冲选项。RFA 可用于治疗关节突神经的超外侧、超内侧和内侧分支。然而,脉冲和冷却的射频消融治疗关节突神经治疗膝骨关节炎疼痛尚未显示出有效性。

目的:我们进行了一项荟萃分析,以评估治疗膝骨关节炎疼痛的非传统、脉冲或冷却的关节突神经 RFA;我们的研究旨在提供有用的信息,以决定是否因为其有效性而使用非传统的 RFA。

研究设计:非传统的、脉冲或冷却的关节突神经 RFA 治疗膝骨关节炎疼痛的荟萃分析研究。

方法:在 PubMed、Ovid MEDLINE、Scopus 和 Cochrane Central 中搜索符合条件的论文。在我们的文献综述中,从选定的研究中汇编和分析了程序、治疗后结果、随访数据和不良事件。使用美国国立心肺血液研究所的质量评估工具来评估治疗相关性和证据强度。我们的荟萃分析分析了治疗前后的疼痛和身体功能评分。主要结果是使用视觉模拟量表或数字评分量表测量的疼痛。次要结果是使用 Western Ontario 和 McMaster 大学骨关节炎指数 (WOMAC) 评分测量的身体功能。

结果:我们的系统评价和荟萃分析包括 11 项符合条件的出版物(604 名患者)。针对关节突神经的冷却和脉冲 RFA 均导致治疗后 1、3、6 和 12 个月疼痛显著减轻(P < 0.005)。在所有随访中,冷却 RFA 技术对身体功能结果没有显著改善。脉冲 RFA 技术在 1 个月和 3 个月随访时对身体功能结果有显著改善。

局限性:局限性包括可用的随机对照试验数量有限,用于比较的方法学基于基线和随访之间的结果变化。只有少数几篇论文报告了完整 WOMAC 评分数据中的身体功能结果。

结论:在 6 个月随访时,针对关节突神经的冷却和脉冲 RFA 均显著缓解了骨关节炎疼痛。针对治疗膝骨关节炎,冷却和脉冲 RFA 对关节突神经的治疗在缓解疼痛方面没有差异。在所有随访中,冷却 RFA 对功能没有显著改善,但脉冲 RFA 对功能的改善可达到 3 个月随访。根据我们的研究,膝关节骨关节炎疼痛可以通过脉冲和冷却射频有效地治疗,且不良反应较少。

相似文献

[1]
The Analgesic Effectiveness of Genicular Nerve-targeted Cooled and Pulsed Radiofrequency Ablation for Osteoarthritis Knee Pain: A Systematic Review and Meta-analysis.

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[2]
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[3]
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[4]
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[5]
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Medicina (Kaunas). 2024-5-24

[6]
Cooled radiofrequency ablation of genicular nerves provides 24-Month durability in the management of osteoarthritic knee pain: Outcomes from a prospective, multicenter, randomized trial.

Pain Pract. 2022-7

[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
Review of Guidelines for Implantable Peripheral Nerve Stimulation (PNS) in the Management of Chronic Pain.

Curr Pain Headache Rep. 2025-5-23

[2]
Genicular Nerve Blocks for the Management of Chronic Knee Pain Related to Osteoarthritis - A Case Series.

Orthop Rev (Pavia). 2024-12-3

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