Lai Shifeng, Li Huimin, Li Jinlian, Ma Yu, Luo Na, Xu Min, Liu Ping, Zhang Hongping, He Qinglan
The People's Hospital of Jianyang City, Jianyang, China.
Jinniu District People's Hospital, Chengdu, China.
Pain Physician. 2025 Nov;28(6):E631-E644.
Knee osteoarthritis (KOA) is a prevalent degenerative disease that leads to significant disability among elderly individuals. Ultrasound-guided pulsed radiofrequency (UG-PRF) has been shown to be a nonpharmacological, less invasive alternative to other treatment methods for reducing severe chronic joint pain.
To establish whether using UG-PRF to manage KOA pain improves short-term and long-term clinical outcomes for patients with that condition.
A systematic review and meta-analysis.
Within PubMed, MEDLINE, Embase, and the Cochrane Library, a comprehensive search of relevant studies published from those databases' inception through July 11, 2024, was conducted. Studies assessing the effectiveness of UG-PRF in KOA patients were selected based on predefined inclusion criteria that required the exclusive use of UG for PRF delivery. Data extraction and synthesis utilized a random-effects model to analyze outcomes related to pain reduction and physical function improvement. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to appraise the robustness of the evidence.
A total of 658 records were identified, with 8 studies involving 688 patients included in the meta-analysis. UG-PRF was associated with significant reductions in visual analog scale (VAS) scores at one month (MD = -14.40; 95% CI [-19.61, -9.19]; P < 0.01; GRADE: high), 3 months (MD = -7.83; 95% CI [-10.38, -5.27]; P < 0.01; GRADE: high), 6 months (MD = -5.64; 95% CI [-7.62, -3.66]; P < 0.01; GRADE: high), and 12 months after treatment (MD = -1.08; 95% CI [-1.94, -0.23]; P < 0.01; GRADE: moderate), and those results all exhibited substantial heterogeneity (I² > 90%; P < 0.01). Similarly, secondary outcomes were associated with significant improvements in WOMAC scores at one month (MD = -20.71; 95% CI [-27.43, -13.99]; P < 0.01; GRADE: high) and 3 months after treatment (MD = -22.09; 95% CI [-31.33, -12.84]; P < 0.01; GRADE: high), with high heterogeneity (I² = 77% at one month, 89% at 3 months; P < 0.01). Sensitivity analysis confirmed the robustness of results, except for the VAS at 12 months. Subgroup analysis indicated no significant differences across treatment targets (P > 0.05). Publication bias was suggested for VAS outcomes at one and 6 months, yet fail-safe analysis (N = 86 required to nullify the 12-month effect) and trim-and-fill methods maintained the significance of the findings.
Incomplete reporting of WOMAC scores constrain the robustness of the study's conclusions, particularly as far long-term efficacy as is concerned. Additionally, the current study's limited data on nerve regeneration mechanisms after pulsed radiofrequency ablation (RFA) restricts a comprehensive understanding of the factors that contribute to pain recurrence at the 12-month mark.
UG-PRF effectively reduces KOA pain and improves function in the short term, with significant benefits observed up to 6 months after treatment. However, the analgesic effects diminish by 12 months, highlighting the need for further research into the long-term efficacy and underlying mechanisms of this technique. The meta-analysis supports the clinical application of UG-PRF as a safe, minimally invasive option for managing KOA pain in adults aged >= 40 years (mean 62.1±9.4 years), though sustained pain relief may require additional interventions.
膝关节骨关节炎（KOA）是一种常见的退行性疾病，会导致老年人出现严重残疾。超声引导下脉冲射频（UG-PRF）已被证明是一种非药物、侵入性较小的替代治疗方法，可减轻严重的慢性关节疼痛。
确定使用UG-PRF治疗KOA疼痛是否能改善该疾病患者的短期和长期临床结局。
系统评价和荟萃分析。
在PubMed、MEDLINE、Embase和Cochrane图书馆中，对从这些数据库建立到2024年7月11日发表的相关研究进行了全面检索。根据预先定义的纳入标准选择评估UG-PRF在KOA患者中有效性的研究，该标准要求仅使用超声引导进行PRF治疗。数据提取和合成采用随机效应模型分析与疼痛减轻和身体功能改善相关的结局。我们使用推荐分级评估、制定和评价（GRADE）框架来评估证据的稳健性。
共识别出658条记录，8项研究涉及688例患者纳入荟萃分析。UG-PRF与治疗后1个月（MD = -14.40；95%CI [-19.61, -9.19]；P < 0.01；GRADE：高）、3个月（MD = -7.83；95%CI [-10.38, -5.27]；P < 0.01；GRADE：高）、6个月（MD = -5.64；95%CI [-7.62, -3.66]；P < 0.01；GRADE：高）和12个月时视觉模拟量表（VAS）评分的显著降低相关（MD = -1.08；95%CI [-1.94, -0.23]；P < 0.01；GRADE：中等），且所有这些结果均表现出高度异质性（I²>90%；P < 0.01）。同样，次要结局与治疗后1个月（MD = -20.71；95%CI [-27.43, -13.99]；P < 0.01；GRADE：高）和3个月时WOMAC评分的显著改善相关（MD = -22.09；95%CI [-31.33, -12.84]；P < 0.01；GRADE：高），异质性较高（1个月时I² = 77%，3个月时I² = 89%；P < 0.01）。敏感性分析证实了结果的稳健性，但12个月时的VAS评分除外。亚组分析表明不同治疗靶点之间无显著差异（P > 0.05）。1个月和6个月时VAS结局提示存在发表偏倚，但失效安全分析（使12个月效应无效需要N = 86）和修剪填充法维持了研究结果的显著性。
WOMAC评分报告不完整限制了研究结论的稳健性，尤其是在长期疗效方面。此外，目前关于脉冲射频消融（RFA）后神经再生机制的数据有限，限制了对导致12个月时疼痛复发因素的全面理解。
UG-PRF可有效减轻KOA疼痛并在短期内改善功能，治疗后6个月内观察到显著益处。然而，镇痛效果在12个月时减弱，突出了对该技术长期疗效和潜在机制进行进一步研究的必要性。荟萃分析支持将UG-PRF作为一种安全、微创的选择应用于≥40岁（平均62.1±9.4岁）成人KOA疼痛的管理，尽管持续缓解疼痛可能需要额外的干预措施。
