Fabris L Kalagac, Maretić S Zanghirella, Petrinović M, Tepšić T
Department of Anesthesia and Resuscitation; Pain Treatment Clinic, Pula General Hospital, Pula, Croatia.
Department of Surgery, Department of Orthopedics and Traumatology, Pula General Hospital, Pula, Croatia.
Acta Clin Croat. 2023 Nov;62(Suppl4):68-76. doi: 10.20471/acc.2023.62.s4.10.
The hyperactive "baby boom" generation is gradually aging, and chronic hip pain has become an increasingly common problem. Most patients with hip pain experience symptoms ranging from mild discomfort to severe pain. They can control the pain with conservative measures, but it inevitably progresses, causing a gradual decline in the quality of life. Conservative therapeutic approaches to hip pain include paracetamol, nonsteroidal anti-inflammatory drugs, narcotics and a variety of physical therapies. Total hip arthroplasty surgery is the only option for patients who experience a gradual decrease in mobility over time and whose pain is unaffected by a conservative approach. For most patients, surgical treatment is a good way to restore quality of life and reduce pain levels, However, this aggressive surgery is not possible in some patients. Many comorbidities in old age limit access to total arthroplasty, while the younger population is at an age where they want to delay surgical treatment. In both of these groups, it is desirable to consider other treatment options and techniques. Minimally invasive percutaneous partial sensory denervation of the hip joint has today become an option that can achieve significant success in providing the desired pain relief without the employment of a surgical knife. Today, there are different modalities for performing this procedure, ranging from diagnostic-pharmacological, radiofrequency (thermal, pulsating and cooled) and cryoablative modes. There is currently broad evidence that suggests that the use of fluoroscopically guided percutaneous radiofrequency ablation of the periarticular branches of the hip joint can provide pain relief for as long as 12-18 months.
活跃的“婴儿潮”一代正逐渐步入老年，慢性髋部疼痛已成为一个日益普遍的问题。大多数髋部疼痛患者的症状从轻度不适到剧痛不等。他们可以通过保守措施控制疼痛，但疼痛不可避免地会进展，导致生活质量逐渐下降。髋部疼痛的保守治疗方法包括对乙酰氨基酚、非甾体抗炎药、麻醉药和各种物理疗法。全髋关节置换手术是那些随着时间推移活动能力逐渐下降且疼痛不受保守治疗方法影响的患者的唯一选择。对大多数患者来说，手术治疗是恢复生活质量和降低疼痛程度的好方法。然而，有些患者无法进行这种激进的手术。老年患者的许多合并症限制了他们接受全关节置换手术的机会，而年轻人群则处于想要推迟手术治疗的年龄。在这两类人群中，都需要考虑其他治疗选择和技术。如今，微创经皮髋关节部分感觉神经去神经支配术已成为一种选择，它无需手术刀就能在缓解疼痛方面取得显著成功。如今，进行该手术有不同的方式，包括诊断 - 药理学、射频（热凝、脉冲和冷却）和冷冻消融模式。目前有广泛的证据表明，使用荧光透视引导下经皮射频消融髋关节周围分支可提供长达12至18个月的疼痛缓解。
