Gülçin HACIBEYOĞLU, Sema TUNCER UZUN, Şule ARICAN, Ruhiye REISLI, Özlem AKKOYUN

Kronik diz ağrısı tedavisinde fluoroskopi-destekli genikular sinir pulsed radyofrekans uygulaması

Amaç: Bu çalışmamızda, primer olarak genikular sinire Pulsed RF uygulamasının diz osteoartrit (OA) hastalarında ağrı ve fonksiyon üzerine etkisini ve yan etkilerini araştırmayı amaçladık. Gereç ve Yöntem: Bu çalışma, Şubat 2018-Haziran 2018 tarihleri arasında gerçekleştirildi. Daha önceden tanı bloğu yapılan hastalar bir gün sonra değerlendirildi, sayısal ağrı skorlarında en az %50 oranında bir düşüş pozitif yanıt olarak kabul edilerek bu hastalar Pulsed RF nörotomi işlemine dahil edildi. Hastaların genikular sinir (GN) dalları USG ile tanımlandı ve floroskopi klavuzluğunda hedef sinirlere radyofrekans (RF) kanülü ilerletildi. Ön-arka ve yan görüntü ile RF kanülü ucunun yeri görüntülendi. Ardından RF bir NT1000 RF Jeneratörü kullanılarak 42 °C’de üç kez beş dakika ara ile 3 genikular sinirlere Pulsed RF tedavisi uygulayarak RF lezyonları oluşturdu. Pulsed RF uygulaması sonrası, herbir genikular sinire 2ml lokal anestezik olarak bupivakain %0,5 enjekte edildi. İşlem öncesi bazal ve işlem sonrası 1, 4 ve 12. haftalardaki sonuç ölçümleri (VAS, pain DETECT skorları, WOMAC skorları) ve Patient Global Impression of Change (PGIC) skoru değerlendirildi. Bulgular: Genikular sinir Pulsed RF uygulanan 20 hasta dahil edildi. Hastaların yaşı (ort±SS) 55.2±3.24, K/E oranı ise 12/8 olarak değerlendirildi. Hastaların ağrı ve fonksiyon değerlendirme WOMAC skorları ve VAS değerleri işlem öncesi dönemle karşılaştırıldığında 12. haftanın sonunda yaklaşık %50 oranında azalma gözlenmiştir. Hiçbir hastada da yan etki gözlenmemiştir. Sonuç: Sonuç olarak, genikular sinirlerin pulsed RF nörotomisinin kronik diz OA hastaları için etkili ve güvenli bir tedavi yöntemi olduğunu düşünmekteyiz.

Fluoroscopy-guided genicular nerves pulsed radiofrequency for chronic knee pain treatment

Objectives: The primary objective of this study was to investigate the effects of Pulsed RF application in the genicular nerveon pain and function in patients with osteoarthritis (OA) and its side effects.Methods: This study was conducted between February 2018 and June 2018. Patients who were previously administered diagnostic blocks were evaluated a day later; a drop of at least 50% in numeric pain scores was considered a positive response, andthese patients were included in the Pulsed RF neurotomy procedures. Radiofrequency (RF) cannula was advanced towardstargeted nerves under the guidance of fluoroscopy. RF lesions were created by applying Pulsed RF treatment to the threegenicular nerves three times with five minutes intervals at 42 °C using NT1000 RF Generator. Following the Pulsed RF application, 2 mL 0.5% bupivacaine was injected into each genicular nerve as an anesthetic agent. VAS, pain DETECT scores, WOMACscores were evaluated preoperative baseline and postprocedure weeks 1, 4, and 12. Patient Global Impression of Change(PGIC) score was evaluated postprocedure weeks 12.Results: This study included 20 patients who were administered genicular nerve Pulsed RF. The mean age was 55.2±3.24 years,and F/M ratio was 12/8. Compared to the pre-procedure period, patients’ pain and function evaluation, WOMAC and VAS values decreased by approximately 50% at the end of the 12th week. No side effect was observed in any patients.Conclusion: Our findings suggest that Pulsed RF neurotomy of the genicular nerves is an efficient and safe treatment methodfor patients with chronic knee osteoarthritis.

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