高选择性神经射频消融联合PRP治疗中重度膝关节炎的疗效分析

Comparison of the efficacy of highly selective peripheral nerve radiofrequency ablation combined respectively with intraarticular injection of PRP and oxygen-ozone in the treatment of knee osteoarthritis

摘要:

目的 观察高选择性外周神经射频消融分别联合关节腔注射富血小板血浆(platelet-rich plasma, PRP)与臭氧治疗膝骨性关节炎的临床疗效。方法 回顾性选取2020年4月至2023年3月我院收治的膝骨性关节炎患者63例,按病人就诊时的治疗方式分组,其中A组31例,B组32例。入院完善检查后,A组于入院第2天、第8天行关节腔注射PRP治疗；B组于入院第2天、第5天、第8天行关节腔注射臭氧治疗；两组均于第8天根据患者疼痛部位行超声引导下外周神经射频消融术。比较两组疼痛视觉模拟评分(visual analogue scale, VAS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)功能量表评分及红外热成像图患侧病变区域与健侧对称区域皮肤温度差值(ΔT),并统计治疗期间不良反应及并发症发生情况。结果 与治疗前(T0)相比,B组VAS、WOMAC功能评分在第一次关节腔注射后1天(T1)及射频术后1天(T2)、1月(T3)、3月(T4)、6月(T5)均降低(P<0.05)；A组VAS、WOMAC功能评分在T1时差异无统计学意义,在T2、T3、T4、T5时均降低(P<0.05)。与治疗前(T0)相比,两组射频术后6个月(T5)时ΔT均降低(P<0.05)。与B组相比,A组VAS评分、WOMAC功能评分在T1、T2时高于B组(P<0.05),T3时两组差异无统计学意义,T4、T5时低于B组(P<0.05)。与B组相比,A组ΔT在射频术后6个月(T5)时低于B组(P<0.05)。两组不良反应及并发症发生率差异无统计学意义。结论 高选择性外周神经射频消融分别联合关节腔注射PRP与臭氧均可有效缓解中重度患者膝关节疼痛、改善关节功能,后者临床起效迅速,短期疗效突出,而前者中远期疗效更佳且稳定,值得临床上进一步推广使用。

Abstract:

Objective The clinical efficacy of highly selective peripheral nerve radiofrequency ablation combined respectively with platelet-rich plasma(platelet-rich plasma, PRP) and oxygen-ozone for knee osteoarthritis was observed. Methods A total of 63 patients with knee osteoarthritis admitted to our hospital from April 2020 to March 2023 were retrospectively selected and grouped according to the treatment mode, including 31 in group A and 32 in group B. After completion examination, Group A received PRP injection on the admission days 2 and 8; Group B received ozone injection on days 2, 5 and 8; and both performed ultrasound-guided radiofrequency ablation of peripheral nerves on the 8th according to pain site.Compared pain visual analogue scores (visual analogue scale,VAS),Western Ontario and McMaster University Osteoarthritis Index (WOMAC) functional scale scores and skin temperature difference (ΔT) between the affected lesion and the infrared thermal map, and count adverse reactions and complications during treatment. Results Compared with pre-treatment (T0), In group B, VAS and WOMAC functional scores decreased at 1 day after the first joint cavity injection(T1) and 1 day(T2), January(T3), March(T4),and June(T5) after radiofrequency surgery(P<0.05); Group A was not statistically different at T1, but decreased at T2, T3, T4, and T5 (P<0.05). ΔT was decreased at 6 months after RF surgery(T5) compared with before treatment(T0) (P<0.05).Compared with group B, VAS score and WOMAC functional score of group A were higher than group B at T1 and T2 (P<0.05), no significant difference between the two groups at T3, and T4 and T5 were lower than that in Group B (P<0.05). Compared with group B, ΔT of group A was lower than Group B at 6 months after RF (T5) (P<0.05). There was no significant difference in the incidence of adverse reactions and complications between the two groups. Conclusion High selective peripheral nerve radiofrequency ablation combined with joint cavity injection PRP or ozone can effectively relieve the pain of knee joint and improve joint function. The latter has rapid clinical effect and outstanding short-term efficacy, while the former has better and stable efficacy in medium and long term, which is worthy of further promotion in clinical practice.