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膝状神经阻滞治疗骨关节炎患者的疗效:有和没有透视辅助的对比研究

Efficacy of Genicular Nerve Block in Patients with Osteoarthritis: A Comparative Study with and without Fluoroscopy Assistance.

作者信息

Said Nour Aliman El Majzoub, Mestriner Alexandre Barbieri, Sungaila Heloisa, Mameri Enzo Salviato, Franciozi Carlos Eduardo Silveira, Kubota Marcelo Seiji

机构信息

Grupo do Joelho e Artroscopia, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil.

出版信息

Rev Bras Ortop (Sao Paulo). 2024 Dec 21;59(6):e876-e882. doi: 10.1055/s-0044-1793825. eCollection 2024 Dec.

Abstract

To compare the efficacy of fluoroscopy as an auxiliary method in genicular nerve block (GNB) with block guidance by anatomical parameters, without imaging aid, in reducing pain.  A total of 23 patients underwent fluoroscopy-guided or anatomical parameter-based GNBs. We applied the Western Ontario and McMaster Universities' Osteoarthritis Index (WOMAC) and the Visual Analog Scale (VAS) for pain at 6 time points (preblock, and after 1 hour, 24 hours, 7 days, 28 days, and 90 days).  The mean age of the sample was of 64.5 ± 4.8 years, and the mean Body Mass Index (BMI), of 31.4 ± 6.1 Kg/m ; 16 subjects (69.6%) were women. The WOMAC pain subscale showed a significant reduction (  < 0.05) in pain in both groups at all time points. This reduction was greater after 1 hour in both groups, with rates if 64.3% and 64.6% in the fluoroscopy and anatomical parameters groups respectively, with no significant difference. At the end of 90 days, the pain reduction rates were of 35.7% and 44.6% in the fluoroscopy and anatomical parameter groups respectively. The VAS also showed a significant reduction (  < 0.05) in pain in both groups at all times. The reduction was more significant after 1 hour: 78.0% in the fluoroscopy group and 82.2% in the anatomical parameter group, with no significant difference. At the end of 90 days, the pain reduction was of in the fluoroscopy group 36.5% and of 24.6% in the anatomical parameters group.  The GNBs guided by fluoroscopy or by anatomical parameters alone were equally effective in terms of magnitude and duration of pain relief.

摘要

为比较在不借助成像辅助的情况下,使用荧光镜检查作为辅助方法在膝神经阻滞(GNB)中与基于解剖学参数的阻滞引导在减轻疼痛方面的疗效。共有23例患者接受了荧光镜引导或基于解剖学参数的GNB。我们在6个时间点(阻滞前、1小时后、24小时后、7天、28天和90天后)应用了西安大略和麦克马斯特大学骨关节炎指数(WOMAC)以及视觉模拟量表(VAS)来评估疼痛。样本的平均年龄为64.5±4.8岁,平均体重指数(BMI)为31.4±6.1kg/m²;16名受试者(69.6%)为女性。WOMAC疼痛子量表显示两组在所有时间点的疼痛均显著减轻(P<0.05)。两组在1小时后疼痛减轻更为明显,荧光镜检查组和解剖学参数组的减轻率分别为64.3%和64.6%,无显著差异。在90天结束时,荧光镜检查组和解剖学参数组的疼痛减轻率分别为35.7%和44.6%。VAS也显示两组在所有时间点的疼痛均显著减轻(P<0.05)。1小时后减轻更为显著:荧光镜检查组为78.0%,解剖学参数组为82.2%,无显著差异。在90天结束时,荧光镜检查组的疼痛减轻率为36.5%,解剖学参数组为24.6%。荧光镜引导或仅由解剖学参数引导的GNB在疼痛缓解的程度和持续时间方面同样有效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b8ba/11663072/348f9c864b47/10-1055-s-0044-1793825-i2300143en-1.jpg

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