常规和水冷单极腰椎射频根切断术的技术方面

Richard D. Ball MD, PhD
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引用次数: 1

摘要

射频消融(RFA)是一种安全有效的疼痛治疗方法,其疗效主要依赖于对神经感觉传入神经的热损伤。大多数外周RFA涉及诱导轴突损伤,但可能间接涉及细胞体。射频电极(RFE)不是简单的高温探头,从电气工程的角度更好地了解RFE功能可以通过减少目标神经加热不良或不充分的风险来改善临床结果。RFE加热受电极周围组织的结构和性质的高度影响,在体外用均匀介质(如蛋清、肝脏或鸡骨骼肌)观察到的RFE产生的蛋白凝固物的形状和大小无疑与体内临床使用中发生的生物病变有显著不同。理解RFA需要考虑特定电极周围组织的性质。介绍了临床有用加热和无用加热的概念,为优化腰椎内侧支神经切开术RFE功能提供了理论基础。传统的RFE在产生射频发生器故障之前,对给定的活性电极表面积产生的电流/加热量是有限的,并且在临床上有用的加热和无用的加热之间存在反比关系。讨论了RFE功能的技术细节,可能与目前接受的技术不同。定时RFE在功能上与传统RFE类似,如果使用得当,可能会有一点优势,如果使用不当,可能会有缺点。在考虑RFE时,直接传导的热量往往被忽略,但应该考虑,特别是水冷RFE (WCRFE)。理论和实证结果表明,WCRFE可能成为许多RFA的首选工具,但不是所有RFA的首选工具,但其采用受到电极成本和报销政策的限制。如果放置不当,常规和定时RFE可能会产生不良结果,但由于过热引起的并发症相当罕见。相反,WCRFE将更多的热量引入电极周围组织,降低了不良临床结果的可能性,但为了避免因邻近组织过热而引起的并发症,需要对WCRFE的空间和热特性有深入的了解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Technical aspects of conventional and water-cooled monopolar lumbar radiofrequency rhizotomy

Radiofrequency ablation (RFA) is a safe and effective pain therapy with efficacy principally reliant upon induced thermal damage of neural sensory afferents. Most peripheral RFA involves induced axonal damage but cell bodies may be involved indirectly. Radiofrequency electrodes (RFE) are not simple high-temperature probes and better insight regarding RFE function from an electrical engineering viewpoint may improve clinical outcomes by reducing the risk of poor or inadequate heating of the target nerves. RFE heating is highly influenced by the configuration and properties of the perielectrode tissues with the shape and size of RFE-produced protein coagulum seen in vitro with homogeneous media such as egg white, liver, or chicken skeletal muscle undoubtedly significantly different than the biological lesions occurring during in vivo clinical use. Understanding RFA requires consideration of the nature of the specific perielectrode tissues. A theoretical basis for optimized RFE function for lumbar medial branch (MB) neurotomy is presented with introduction of the concepts of clinically useful heating and useless heating. Conventional RFE is limited in the amount of current/heating produced for a given active electrode surface area before producing a radiofrequency generator fault and an inverse relationship exists between clinically useful heating and useless heating. Technical details of RFE function are discussed that may differ from presently accepted technique. Tined RFE, similar in function to conventional RFE, may offer a small advantage if properly used, and possibly a disadvantage if used incorrectly. Directly conducted heat is often neglected in considering RFA, but should be considered, especially with water-cooled RFE (WCRFE). Theory and empirical results suggest that WCRFE might become a preferred tool for much, but not all, RFA, but adoption has been limited by electrode cost and reimbursement policies. Conventional and tined RFE may produce poor outcomes if placed improperly, but complications due to overheating are quite rare. Conversely, WCRFE introduces far more heat into perielectrode tissues and reduces the likelihood of a poor clinical outcome, but avoidance of complications due to overheating of adjacent tissues requires a thoughtful understanding of the spatial and thermal characteristics of the WCRFE.

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