背景:膝关节骨性关节炎(OA)影响了19%的45岁以上的美国成年人,每年花费270亿美元。广泛的非手术治疗方案是可用的。这项研究比较了六种治疗方法:冷冻神经溶解与深膝状神经阻滞(冷冻深/两者),浅表神经阻滞冷冻神经溶解术(冷冻浅表),关节内透明质酸(IA-HA)注射,非甾体抗炎药注射剂(IA-NSAIDs),IA-皮质类固醇(IA-CS)注射,或在4个月内注射IA-曲安奈德缓释(IA-TA-ER),用于:1)疼痛严重程度和镇痛使用;和2)身体功能(来自膝关节损伤和骨关节炎的关节置换结果评分(KOOS,JR))。
方法:单侧膝关节OA并接受非手术干预的患者被纳入遗传结果创新(iGOR)登记,一本小说,多中心真实世界注册表,2021年9月至2024年2月。共纳入480例患者。在基线时评估疼痛和功能结果。每周,每月,分析为:总体趋势,治疗前后的幅度变化,和基于分布的最小临床重要差异评分(MCID)。对7个混杂因素进行校正的多变量线性回归用于比较6个治疗组的随访结果。
结果:使用IA-TA-ER注射与最低疼痛相关,最大的疼痛减轻,与其他治疗相比,达到MCID的患者患病率最高(P<0.001)。Deep/Both-Cryo和IA-CS与实现MCID的患病率高于IA-HA相关,IA-NSAIDs,和低温表面(P≤0.001)。IA-TA-ER的使用也与最大的功能评分相关,从基线改进,与其他治疗相比,达到MCID的患者患病率最高(P≤0.003)。
结论:在治疗后4个月内,IA-TA-ER在疼痛缓解和功能改善方面似乎优于其他治疗。此外,新型冷冻神经溶解和常规IA-CS的结局相似,且优于IA-HA和IA-NSAIDs.
BACKGROUND: Knee osteoarthritis (OA) affects 19% of American adults aged more than 45 years and costs $27+ billion annually. A wide range of nonoperative treatment options are available. This study compared 6 treatments: cryoneurolysis with deep genicular nerve block (Cryo-Deep/Both), cryoneurolysis with superficial nerve block (Cryo-Superficial), intra-articular hyaluronic acid (IA-HA) injections, nonsteroidal anti-inflammatory drug injections (IA-NSAIDs), IA-corticosteroids (IA-CS) injections, or IA-triamcinolone extended release (IA-TA-ER) injections over 4 months for: (1) pain severity and analgesic use; and (2) physical function (from Knee Injury and Osteoarthritis Outcome Score for Joint Replacement).
METHODS: Patients who had unilateral knee OA and received nonoperative intervention were enrolled in the Innovations in Genicular Outcomes Research registry, a novel, multicenter real-world registry, between September 2021 and February 2024. A total of 480 patients were enrolled. Both pain and functional outcomes were assessed at baseline, weekly, and monthly, which were analyzed by overall trend, magnitude changes pretreatment to post-treatment, and distribution-based minimally clinically important difference (MCID) score. Multivariate linear regressions with adjustments for 7 confounding factors were used to compare follow-up outcomes among 6 treatment groups.
RESULTS: Use of IA-TA-ER injections was associated with the lowest pain, greatest pain reduction, and highest prevalence of patients achieving MCID relative to other treatments (P < .001). Deep/Both-Cryo and IA-CS were associated with a higher prevalence of achieving MCID than IA-HA, IA-NSAIDs, and Cryo-Superficial (P ≤ .001). Use of IA-TA-ER was also associated with the greatest functional score, improvement from baseline, and highest prevalence of patients achieving MCID than other treatments (P ≤ .003).
CONCLUSIONS: The IA-TA-ER appears to outperform other treatments in terms of pain relief and functional improvement for up to 4 months following treatment. In addition, outcomes in the novel cryoneurolysis and conventional IA-CS were similar to one another and better than those in IA-HA and IA-NSAIDs.