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目的 ：比较超声引导下单极射频(monopolar radiofrequency, MRF)热凝与双极射频(bipolar radiofrequency,BRF)热凝对中重度膝骨关节炎患者术后12个月疼痛及膝关节功能改善的差异。方法：选择2022年6月—2023年6月于南通大学附属医院疼痛科就诊的中重度膝骨关节炎(Kellgren-LawrenceⅢ～Ⅳ级)患者94例，随机分为MRF组与BRF组，每组47例。两组均在超声引导下对膝内侧上、下神经与膝外侧上神经射频热凝(80℃，90 s)。主要结局为术后1、3、6、12个月VAS评分，西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)评分，镇痛药物量化表(medication quantification scaleⅢ, MQS-Ⅲ)评分及治疗相关并发症。结果：两组术后各时间点VAS评分，WOMAC评分以及口服镇痛药物用量均小于术前(P<0.05)；在治疗后1、3个月时，两组各评分差异无统计学意义；治疗后6个月时，BRF组VAS评分显著低于MRF组(P<0.05)；治疗后12个月时，BRF组VAS评分及WOMAC评分显著低于MRF组(P<0.05)。术后两组口服镇痛药物用量均低于术前(P<0.05),BRF组在术后12个月时显著低于MRF组(P<0.05)；两组并发症发生情况差异无统计学意义。结论：两种治疗方式均可有效改善膝关节炎患者的疼痛与功能；超声引导下BRF热凝治疗中重度膝骨关节炎的长期效果显著优于MRF，且安全可靠。
Abstract：Objective: To compare the long-term efficacy of ultrasound-guided monopolar versus bipolar radiofrequency thermocoagulation for alleviating pain and improving knee function in patients with moderate-to-severe osteoarthritis at the 12-month follow-up. Methods: A total of 94 patients with moderate-to-severe knee osteoarthritis(Kellgren-Lawrence grade Ⅲ-Ⅳ)were enrolled in this study. They were recruited from the Pain Department of Affiliated Hospital of Nantong University between June 2022 and June 2023 and subsequently randomly allocated into two groups: a monopolar radiofrequency(MRF)group and a bipolar radiofrequency(BRF) group, with 47 patients in each group. Both groups underwent ultrasound-guided radiofrequency thermocoagulation(80 °C, 90 s) targeting the superior genicular nerve, inferior genicular nerve, and superior lateral genicular nerve. The primary outcomes included VAS scores, Western Ontario and McMaster Universities osteoarthritis index(WOMAC) scores, analgesic medication quantification scale Ⅲ(MQS-Ⅲ) scores, and treatment-related complications at1, 3, 6, and 12 months postoperatively. Results: VAS scores, WOMAC scores, and analgesic medication usage in both groups were lower at all postoperative time points compared with preoperative values(P<0.05). At 1 and 3 months after treatment, there were no significant differences between the two groups in any of the scores. At 6 months post-treatment, the BRF group showed significantly lower VAS scores than the MRF group(P<0.05). At 12 months post-treatment, both VAS and WOMAC scores in the BRF group were significantly lower than those in the MRF group(P<0.05). Analgesic medication usage in both groups was lower than preoperative levels(P<0.05), with the BRF group showing significantly lower usage than the MRF group at 12 months(P<0.05). There was no statistically significant difference in treatment-related complications between the two groups.Conclusion: Both treatment methods effectively improved pain and function in patients with knee osteoarthritis. These results indicate that for patients with moderate-to-severe knee osteoarthritis, ultrasound-guided BRF offers superior long-term efficacy and a similarly favorable safety profile compared with MRF.
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基本信息:
DOI：10.16424/j.cnki.cn32-1807/r.2025.06.005
中图分类号:R684.3
引用信息:
[1]黄炎,罗克清,张金科,等.超声引导下单极与双极射频热凝治疗中重度膝骨关节炎的效果对比[J].南通大学学报(医学版),2025,45(06):534-539.DOI:10.16424/j.cnki.cn32-1807/r.2025.06.005.
基金信息:
国家自然科学基金面上项目(82471249); 江苏省自然科学基金面上项目(BK20211107)