多模式膝神经射频消融术对比膝关节注射治疗难治性膝关节炎的临床疗效及安全性分析

Clinical efficacy and safety analysis of knee nerve multi-mode radiofrequency combined with knee joint injection in the treatment of refractory knee osteoarthritis

摘要:

回顾性分析普通射频联合低温等离子射频消融术与膝关节腔内注射医用几丁糖治疗难治性膝骨关节炎的临床疗效和安全性。方法：纳入2020年2月至2021年3月在中日友好医院疼痛科治疗的难治性膝骨关节炎的66名患者，其中手术组35人、注射组31人，分别在术前、术后第2周、1个月、3个月、6个月、12个月应用数字疼痛分级法评分、西安大略和麦克马斯特大学骨关节炎指数评分、药物使用率、手术相关并发症、患者的满意度进行随访评估以及统计学分析。结果：与术前相比，手术组疗效优于注射组，在术后2周、1个月、3个月、6个月、12个月的NRS和WOMAC评分、术后药物使用率均明显下降，差异均具有统计学意义；术后未观察到下肢麻木、下肢无力、感觉减退、感觉异常、神经痛等严重不良反应。术后12个月后，82.9%的手术组患者均对术后效果满意。结论：膝神经射频联合低温等离子射频消融术可以有效缓解膝关节疼痛，改善关节功能，并且未发现严重不良反应，可以作为全膝关节置换术以外的难治性KOA的替代治疗模式。

Abstract:

Objective:This retrospective study compared the clinical efficacy and safety of knee nerve multi-mode radiofrequency vs knee joint injection in the treatment of refractory knee osteoarthritis(KOA). Methods: 66 patients with refractory KOA who received treatment at the Pain Depatmrent of China-Japan Friendship Hospital from February 2020 to March 2021 were dividided into the surgery group（n=35） and the injection group（n=31）. The patients' numerical rating scale (NRS) score, the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) score, the proportion of nonsteroidal antiinflammatory drugs (NSAIDs) and/or opioid drugs used, surgical related complications and patient satisfaction，before surgery, at the second week,the first month,the third month,the 6th month and the 12th month after surgery, were respectively followed up and statistically analyzed. Result: Compared with pre-operation, the surgical group had better efficacy than the injection group. The NRS score and WOMAC score, as well as the postoperative drug use rate, decreased significantly at the second week,the first month,the third month,the 6th month and the 12th month after surgery，with statistical significance. No serious adverse reactions such as lower limb numbness, lower limb weakness, hypoesthesia, paresthesia, and neuralgia were observed after surgery. At the 12th month after surgery, 82.9% of the patients were satisfied with the postoperative results. Conclusion: The combination of knee nerve radiofrequency and low-temperature plasma radiofrequency ablation can effectively alleviate knee joint pain, improve joint function, and have no serious adverse reactions，which can be used as an alternative treatment mode for refractory KOA other than total knee arthroplasty.