Ultrasound-Guided Radiofrequency Ablation for Chronic Osteoarthritis Knee Pain in the Elderly: A Randomized Controlled Trial
超声引导射频消融术治疗老年人慢性骨关节炎膝关节疼痛:一项随机对照试验
论文摘要
Background: Osteoarthritis of the knee (KOA) is the main cause of disability in elderly people.
Patients with KOA may often not achieve adequate pain control even after receiving all treatment modalities.
膝关节骨关节炎(KOA)是老年人致残的主要原因。
KOA患者即使接受了所有的治疗方式，也可能经常无法达到适当的疼痛控制。
Objectives: The objective of this study was to examine the efficacy of ultrasound-guided radiofrequency ablation (RFA) as a treatment for moderate and severe KOA.
本研究的目的是探讨超声引导射频消融(RFA)治疗中重度KOA的疗效。
Study Design: A prospective randomized controlled study.
前瞻性随机对照研究。
Setting: The study was performed in the National Pain Management and Research Center of China-Japan Friendship Hospital.
本研究在中日友好医院国家疼痛管理研究中心进行。
Methods: Eligible participants were over 50 years old and had suffered from chronic knee joint pain for more than 6 months, scoring at least 4 on a numeric rating scale (NRS) and grade III–IV according to the Kellgren-Lawrence classification system. The target nerve selection principle was as follows: the superomedial genicular nerve (SMGN) branch and inferior medial genicular nerve (IMGN) branch of the saphenous nerve for medial knee pain, the superolateral genicular nerve (SLGN) branch of the femoral nerve for lateral pain, and the SMGN, IMGN, and SLGN branches for total knee pain. The main outcomes were the NRS pain score (including the most severe pain), the average pain, and the proportion of patients who had reached pain reduction of more than 2 points. The secondary outcome was the Western Ontario McMaster University Osteoarthritis Index (WOMAC) score. RFA at 70ºC was performed for 120 seconds per patient in the RFA group, and knee nerve blocks were performed in the control group.
符合条件的参与者年龄超过50岁，患有慢性膝关节疼痛超过6个月，根据Kellgren-Lawrence分类系统，在数字评定量表(NRS)和III-IV级评分至少为4分。靶神经选择原则为:膝内侧疼痛选择隐神经膝内侧上神经(SMGN)分支和膝内侧下神经(IMGN)分支，外侧疼痛选择股神经膝外侧上神经(SLGN)分支，全膝疼痛选择SMGN、IMGN和SLGN分支。主要观察结果为NRS疼痛评分(包括最剧烈疼痛)、平均疼痛、疼痛减轻2分以上患者比例。次要终点是西安大略麦克马斯特大学骨关节炎指数(WOMAC)评分。RFA组每例患者在70ºC下进行RFA，时间为120秒，对照组进行膝关节神经阻滞。
Results: A total of 120 patients who met the inclusion criteria were selected in this study. The treatment groups showed significant differences in their mean NRS scores and worst pain during the first, third, and sixth months after treatment. There were significant differences in the mean WOMAC pain, physical function, and total scores between the treatment groups and over time.
本研究共纳入符合纳入标准的患者120例。治疗组在治疗后的第一个月、第三个月和第六个月的平均NRS评分和最严重疼痛表现出显著差异。治疗组和治疗时间之间的平均WOMAC疼痛、身体功能和总分有显著差异。
Between the treatment groups and over time, the mean WOMAC stiffness scores were not different. At each time point after treatment, the proportion of patients who needed analgesic drugs was significantly lower in the RFA group than in the control group. Univariate analysis showed that gender, age, pain course, and body mass index were not significantly correlated with the positive rate (NRS ≥ 2 score reduction). After we adjusted for multiple factors, the perceived beneficial effect of therapy was less when gonarthritis was more severe (P < 0.01).
在治疗组之间和随时间推移，平均WOMAC僵硬评分没有差异。在治疗后各时间点，RFA组需要镇痛药物的患者比例明显低于对照组。单因素分析显示，性别、年龄、疼痛病程、体重指数与阳性率无显著相关(NRS≥2分降低)。在我们对多因素进行调整后，当膝关节炎越严重时，感知到的治疗有益效果越少(P < 0.01)。
Limitation: This study’s limitation is that it was performed in only one unit of the National Pain Management and Research Center.
这项研究的局限性在于它只在国家疼痛管理和研究中心的一个单位进行。
Conclusions: Ultrasound-guided RFA applied to knee nerves can significantly reduce KOA pain, improve knee joint function, improve patient satisfaction, and provide a feasible, safe, and effective minimally invasive procedure for moderate to severe KOA in elderly patients.
超声引导下膝关节神经射频消融术可显著减轻KOA疼痛，改善膝关节功能，提高患者满意度，为中重度老年KOA患者提供一种可行、安全、有效的微创治疗方法。
主要结果
1.Primary Outcome (NRS Scores) The 2 treatment groups showed significant differences in the mean NRS scores and the worst pain, and these differences were also significant over time (Table 3). If the patient had osteoarthritis in both knees, they reported an average score for both knees.主要结局(NRS评分)两个治疗组在平均NRS评分和最严重疼痛方面有显著差异，这些差异随着时间的推移也很显著
2. There were significant differences in the mean WOMAC pain, physical function, and total score between the treatment groups and over time. The mean WOMAC stiffness scores did not differ significantly between the treatment groups or over time
治疗组和治疗时间之间的平均WOMAC疼痛、身体功能和总分有显著差异。平均WOMAC僵硬评分在治疗组之间或不同时间没有显著差异
The RFA group’s GPE scores at the first, third, and sixth months were significantly better than those of the control group (6.10 ± 0.88 vs. 5.32 ± 0.79, 5.51 ± 0.97 vs.
4.81 ± 0.90, 5.14 ± 0.80 vs. 4.52 ± 0.50), with statistical differences between the groups (P < 0.05).
RFA组患者第1、3、6个月GPE评分均显著优于对照组，组间差异有统计学意义(P < 0.05).
3.In the RFA group, the proportion of patients who needed postoperative analgesic drugs at each time point was significantly lower than in the control group (16.36% vs. 43.64%, 22.64% vs. 46.30%, 25.49% vs. 64.15%), and there were statistical differences between the groups (P < 0.0, Table 5).
RFA组各时间点术后需要镇痛药物的患者比例均显著低于对照组(16.36% vs. 43.64%， 22.64% vs. 46.30%， 25.49% vs. 64.15%)，组间差异有统计学意义(P < 0.0，表5)。
4.Univariate analysis showed that gender, age, pain course, and BMI were not significantly correlated with the positive rate (NRS ≥ 2 score reduction). The likelihood of a successful outcome at 6 months decreased when gonarthrosis was more severe (P < 0.01) After adjusting for multiple factors, we found that the perceived beneficial effect of therapy also decreased in cases of more severe gonarthrosis (P < 0.01) (Table 6)
单因素分析显示，性别、年龄、疼痛病程、BMI与阳性率无显著相关(NRS≥2分降低)。当关节病更严重时，6个月时成功结局的可能性降低(P < 0.01)。在调整多因素后，我们发现，在关节病更严重的情况下，治疗的感知有益效果也降低(P < 0.01).
超声引导射频消融术治疗老年人慢性骨关节炎膝关节疼痛一项随机对照试验.pdf
文章：差劲先生
排版：肉肉
