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冷却射频消融术对日本膝骨关节炎患者步行能力的短期影响

Short-Term Effects of Cooled Radiofrequency Ablation on Walking Ability in Japanese Patients with Knee Osteoarthritis.

作者信息

Hiromura Kentaro, Kitajima Hironori, Hatakenaka Chie, Shimizu Yoshiaki, Miyagaki Terumasa, Mori Masayuki, Nakashima Kazuhei, Fuku Atsushi, Hirata Hiroaki, Tachi Yoshiyuki, Kaneuji Ayumi

机构信息

Department of Orthopedic Surgery, Kanazawa Medical University, Kahoku 920-0293, Japan.

Department of Orthopedic Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi 935-8531, Japan.

出版信息

J Clin Med. 2024 Nov 22;13(23):7049. doi: 10.3390/jcm13237049.

Abstract

: Knee osteoarthritis (KOA) is a degenerative joint disease typically managed with conservative treatments, such as anti-inflammatory medications and intra-articular hyaluronic acid injections; however, advanced cases may eventually require surgical intervention. Recently, cooled radiofrequency ablation (CRFA) has emerged as a novel treatment option for alleviating KOA-related pain by temporarily disabling pain-transmitting nerves. This study evaluated the short-term effects of CRFA on pain relief and walking ability in KOA patients, with a specific focus on functional improvements in walking capacity. : This study included 58 patients (71 knees) with KOA who underwent CRFA after experiencing inadequate pain control with conservative treatments. The cohort consisted of 28 men and 30 women, with a mean age of 75.2 years (55-90). Under ultrasound guidance, CRFA was performed on the superior lateral geniculate nerve, superior medial geniculate nerve, and inferior medial geniculate nerve, with each targeted nerve ablated. Pre- and post-procedural evaluations (one month after CRFA) included assessments of visual analog scale (VAS) scores for pain at rest and during walking, range of motion (ROM), knee extensor strength, walking speed, and gait stability. : Significant improvements in the mean VAS (rest/walking) and mean walking speed (comfortable/maximum) were observed following CRFA. However, no significant changes were noted in ROM, knee extensor strength, or walking stability. : These findings suggest that rehabilitation may be essential to further enhance walking stability. Overall, CRFA appears to be a promising short-term treatment option for reducing VAS pain scores and enhancing walking speed in patients with KOA.

摘要

膝骨关节炎(KOA)是一种退行性关节疾病,通常采用保守治疗,如抗炎药物和关节内注射透明质酸;然而,晚期病例最终可能需要手术干预。最近,冷射频消融(CRFA)已成为一种新的治疗选择,通过暂时使疼痛传递神经失能来减轻与KOA相关的疼痛。本研究评估了CRFA对KOA患者疼痛缓解和步行能力的短期影响,特别关注步行能力的功能改善。

本研究纳入了58例(71膝)KOA患者,这些患者在保守治疗疼痛控制不佳后接受了CRFA。该队列包括28名男性和30名女性,平均年龄75.2岁(55 - 90岁)。在超声引导下,对膝上外侧神经、膝上内侧神经和膝下内侧神经进行CRFA,对每条目标神经进行消融。术前和术后评估(CRFA后1个月)包括评估静息和步行时疼痛的视觉模拟量表(VAS)评分、关节活动范围(ROM)、膝伸肌力量、步行速度和步态稳定性。

CRFA后观察到平均VAS(静息/步行)和平均步行速度(舒适/最大)有显著改善。然而,ROM、膝伸肌力量或步行稳定性没有显著变化。

这些发现表明,康复对于进一步提高步行稳定性可能至关重要。总体而言,CRFA似乎是一种有前景的短期治疗选择,可降低KOA患者的VAS疼痛评分并提高步行速度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/28a5/11642253/44c88eb062a9/jcm-13-07049-g001.jpg

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