摘要
膝关节骨关节炎(OA)是临床常见的退行性关节疾病,其治疗仍面临挑战。超声引导下膝关节神经阻滞术作为新兴的微创治疗技术,通过向支配膝关节的感觉神经周围注射局麻药(联合或不联合糖皮质激素),可有效缓解疼痛并改善关节功能。在此基础上发展的膝关节神经射频消融术(RFA)利用物理能量选择性破坏感觉神经传导功能,阻断疼痛信号向中枢神经系统传递。现有证据表明,超声引导下膝关节神经阻滞术已成为膝关节OA疼痛及全膝关节置换术(TKA)后急性疼痛的有效手段;而超声引导膝关节神经RFA不仅适用于OA疼痛治疗,对TKA术后慢性疼痛亦显示出显著疗效优势。然而,在技术细节方面(包括消融方法、消融次数、靶神经选择标准、术前神经阻滞的疗效预测价值、术后皮质激素使用指征等),仍需通过大样本随机对照试验提供高级别的循证医学证据。
Knee osteoarthritis(OA)is a common clinical degenerative joint disease,and its treatment remains challenging.Ultrasound-guided knee nerve block,as an emerging minimally invasive treatment technology,can effectively relieve pain and improve joint function by injecting local anesthetics(with or without glucocorticoids)around the sensory nerves innervating the knee joint.On this basis,knee nerve radiofrequency ablation(RFA)utilizes physical energy to selectively disrupt the conduction function of sensory nerves,blocking the transmission of pain signals to the central nervous system.Existing evidence shows that ultrasound-guided knee nerve block has become an effective approach for knee OA pain and acute pain after total knee arthroplasty(TKA);meanwhile,ultrasound-guided knee nerve RFA is not only applicable to OA pain management but also demonstrates significant efficacy advantages in chronic pain after TKA.However,regarding technical details(including ablation methods,frequency of ablation,selection criteria for target nerves,predictive value of preoperative nerve block for efficacy,indications for postoperative corticosteroid use,etc.),high-level evidence-based medical evidence is still required through large-sample randomized controlled trials.
作者
王月香
WANG Yuexiang(Department of Ultrasound,the Second Medical Center,Chinese PLA General Hospital,Beijing 100080,China)
基金
国家自然科学基金(82472001)。
关键词
骨关节炎
膝关节神经阻滞
超声检查
射频消融术
Osteoarthritis
Genicular nerve block
Ultrasonography
Radiofrequency ablation
