关节镜下肩袖修复手术前射频消融末端感觉关节神经改善术后早期功能结局：一项3个月随访的初步研究。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-02-01 DOI:10.1016/j.jisako.2024.100379

Marvin Thepsoparn , Arunthip Luechoowong , Thanathep Tanpowpong , Danaithep Limskul

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引用次数: 0

摘要

简介：由肩袖撕裂引起的慢性肩痛通常通过关节镜下肩袖修复手术（ARCR）治疗。然而，ARCR可能与中度至重度术后疼痛相关，疼痛控制不佳可导致功能恢复延迟和肩周炎的发展。末端感觉关节神经射频消融术（RFA）已被证明是临床有效的患者严重难治性肩痛从多种病因。我们的目的是研究术前RFA是否会改善ARCR术后的疼痛和功能结果。方法：在这项前瞻性先导研究中，参与者被随机分配在选择性ARCR前1-5天接受透视引导的末端感觉关节神经冷却RFA (CRFA)（冈上神经、腋窝神经、胸外侧神经）作为干预组，与没有事先RFA的ARCR作为对照组相比。在ARCR后1、2、3、4、5、6周和3个月分别评估恒定评分（CS）、美国肩肘外科医生评分（ASES）和疼痛数值评定评分（NRS）。结果：本研究共纳入21例受试者，其中对照组11例，冷却RFA组10例。冷却RFA组在6周和3个月时CS和ASES均有统计学意义上的改善。两组在所有时间点的疼痛结果均无差异。未见干预相关并发症。结论：作为多模式术后疼痛管理方案的一部分，在选择性ARCR前1-5天对冈上神经、腋窝神经和胸外侧神经的末端感觉关节分支进行冷却RFA可以改善早在6周的功能结果。证据水平：III。

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Radiofrequency ablation of terminal sensory articular nerves before arthroscopic rotator cuff repair surgery improved early postoperative functional outcomes: A pilot study with 3 months follow-up

Introduction

Chronic shoulder pain caused by a rotator cuff tear is commonly treated with arthroscopic rotator cuff repair surgery (ARCR). However, ARCR may be associated with moderate-to-severe postoperative pain, and poorly controlled pain can result in delayed functional recovery and the development of frozen shoulder. Terminal sensory articular nerve radiofrequency ablation (RFA) has been shown to be clinically effective in patients with severe refractory shoulder pain from multiple etiologies. We aimed to investigate whether preoperative RFA would improve the postoperative pain and functional outcomes after ARCR.

Methods

In this prospective pilot study, participants were randomized to receive fluoroscopic-guided terminal sensory articular nerve-cooled RFA (CRFA) (supraspinatus nerve, axillary nerve, lateral pectoral nerve) 1–5 days prior to elective ARCR as an intervention group compared to ARCR without prior RFA as a control group. Constant score (CS), American Shoulder and Elbow Surgeon score (ASES), and pain numerical rating score (NRS) were assessed at 1, 2, 3, 4, 5, and 6 weeks and 3 months following ARCR.

Results

Twenty-one participants were enrolled in this study, including 11 in the control group and 10 in the cooled RFA group. The cooled RFA group showed statistically significantly better CS and ASES both at 6 weeks and 3 months. The two groups showed no differences in pain outcomes at all time points. No intervention-related complications were noted.

Conclusion

Cooled RFA of the terminal sensory articular branches of the supraspinatus, axillary, and lateral pectoral nerves performed 1–5 days prior to elective ARCR as part of a multimodal postoperative pain management regimen can improve functional outcomes as early as 6 weeks.