膝關節痛_射頻神經消融術

【文章摘要】

膝關節痛嚴重影響長者生活質素，但並非所有人都適合或願意進行關節置換手術。射頻神經消融術（Radiofrequency Denervation）是一種成熟且微創的痛症介入治療，透過熱力阻斷傳遞痛楚的神經訊號。治療後，約七成患者的膝痛可減少一半或以上，效果可維持 6 至 12 個月。此技術同樣適用於髖關節及肩關節痛症。

嚴重膝關節痛的新出路：認識微創「射頻神經消融術」

隨著人口老化，慢性膝關節痛已成為一個不容忽視的健康及社會問題。嚴重的膝痛不僅妨礙日常活動，更會影響社交生活與整體身心健康。當痛楚嚴重導致行動不便時，許多人會考慮進行人工關節置換手術。然而，並非所有人都適合動大手術——例如年紀過輕、本身患有其他慢性疾病導致手術風險過高，又或者病人本身抗拒在體內植入金屬配件。

在這些情況下，患者可以考慮另一種微創選擇：「射頻神經消融術」（Radiofrequency Denervation，或稱射頻消融術）。

什麼是射頻神經消融術？

射頻神經消融術是一項發展成熟的痛症介入治療。早於 1970 年代，這項技術已被應用於治療背部小關節痛等問題；而在近十至二十年間，醫學界開始將這項技術進一步延伸至治療大關節的慢性痛症，特別是膝關節退化。

人體的關節周圍佈滿了負責傳遞痛楚訊號的感覺神經。以膝關節為例，醫學研究顯示，負責供應膝關節痛覺的神經分支可多達十條或以上。射頻治療的基本原理，就是針對這些特定的感覺神經進行阻斷。

在進行治療時，醫生會利用超聲波或 X 光等實時醫學影像技術，精準地找出這些感覺神經的位置。接著，醫生會將一根特製的射頻針放置在神經線旁邊，並連接至射頻儀器。儀器會產生高頻交流電，利用電流產生的熱力，將傳遞痛楚的感覺神經「燒融」。這項程序只會針對感覺神經，不會影響控制肌肉活動的運動神經，因此不會削弱患者的活動能力。

治療效果與持久度

醫學研究及臨床數據顯示，射頻神經消融術的效果相當顯著。在完成治療後，大約有70%患者的膝關節痛楚可以減少一半或以上。

由於被消融的神經線會隨著時間緩慢地再生，這種痛楚紓緩雖然不是永久性，但通常可以維持 6 至 12 個月，部分患者甚至能感受到長達一年以上的改善。這段無痛或減痛的「空窗期」，能讓患者重新投入日常生活，並有能力進行物理治療來強化關節周圍的肌肉，從根本改善關節健康。

如何提高治療成功率？

為了確保治療的準確度及成功率，醫生通常會在正式進行射頻消融前，先為患者進行一次「診斷性神經阻滯」（Diagnostic Nerve Block）。

過程中，醫生會先用超聲波或 X 光找出目標神經線，並在神經線周圍注射少量的局部麻醉藥。隨後，醫生會評估患者在麻醉藥生效期間的痛楚減輕程度。如果患者對麻醉反應良好（即痛楚有顯著下降），這就意味著找對了引發痛楚的「元兇」，之後再進行射頻神經消融的成功率便可高達八成以上。

不只限於膝蓋：髖關節與肩關節的應用

除了膝關節痛，射頻神經消融技術亦可應用於人體的其他大型關節。對於患有慢性髖關節痛（Hip Pain）或肩關節痛（Shoulder Pain），且對傳統止痛藥或注射治療無效的患者，這項技術同樣提供了一個微創的止痛新希望。

總括而言，射頻神經消融術為受慢性關節痛困擾的患者提供了一個安全、不需開刀的有效選擇。

[Article Summary]

Severe knee pain heavily impacts the quality of life for older adults, but not everyone is suitable for or willing to undergo joint replacement surgery. Radiofrequency denervation is a well-established, minimally invasive interventional pain treatment that uses heat to block pain signals. After treatment, about 70% of patients experience a 50% or greater reduction in knee pain, with effects lasting 6 to 12 months. This technique is also applicable to hip and shoulder joint pain.

A New Way Out for Severe Knee Pain: Understanding Minimally Invasive

Radiofrequency Denervation

With an ageing population, chronic knee pain has become a significant health and social issue. Severe knee pain not only hinders daily activities but also affects social life and overall physical and mental well-being. When pain becomes so severe that it limits mobility, many people consider artificial joint replacement surgery. However, major surgery is not suitable for everyone. For instance, a patient might be too young, have other chronic illnesses that make surgery too risky, or simply be reluctant to have metal implants in their body.

In these situations, patients can consider another minimally invasive option: Radiofrequency Denervation (also known as radiofrequency ablation).

What is Radiofrequency Denervation?

Radiofrequency denervation is a well-established interventional pain treatment. As early as the 1970s, this technique was already being used to treat issues like facet joint pain in the back. Over the past 10 to 20 years, the medical community has further extended its application to treat chronic pain in large joints, particularly knee degeneration.

The areas around our joints are filled with sensory nerves responsible for transmitting pain signals. Taking the knee joint as an example, medical research shows there can be ten or more nerve branches supplying pain sensation to the area. The basic principle of radiofrequency treatment is to specifically target and block these sensory nerves.

During the procedure, the doctor uses real-time medical imaging, such as ultrasound or X-rays, to accurately locate these sensory nerves. Next, a specialised radiofrequency needle is placed next to the nerve and connected to a radiofrequency machine. The machine generates a high-frequency alternating current, using the resulting heat to ablate or ‘’burn‘’ the sensory nerves transmitting the pain. This procedure exclusively targets sensory nerves and does not affect the motor nerves that control muscle movement, so it will not weaken the patient’s mobility.

Treatment Effectiveness and Duration

Medical research and clinical data show that the effects of radiofrequency denervation are highly significant. After completing the treatment, approximately 70% of patients experience a 50% or greater reduction in their knee pain.

Because the ablated nerves will slowly regenerate over time, this pain relief is not permanent. However, it typically lasts for 6 to 12 months, with some patients experiencing improvements for well over a year. This ‘window’ of being pain-free or having reduced pain allows patients to return to their daily lives. It also gives them the ability to undergo physiotherapy to strengthen the muscles surrounding the joint, fundamentally improving joint health.

How to Increase the Success Rate?

To ensure the accuracy and success rate of the treatment, doctors usually perform a ‘diagnostic nerve block’ before the actual radiofrequency ablation.

During this process, the doctor first uses ultrasound or X-rays to locate the target nerves and injects a small amount of local anaesthetic around them. Subsequently, the doctor assesses the degree of pain relief while the anaesthetic is active. If the patient responds well to the anaesthesia (meaning there is a significant drop in pain), it indicates that the true ‘culprit’ causing the pain has been correctly identified. Following this, the success rate of the radiofrequency denervation can reach over 80%.

Beyond the Knee: Hip and Shoulder Applications

In addition to knee pain, radiofrequency denervation technology can also be applied to other large joints in the body. For patients suffering from chronic hip pain or shoulder pain who have not responded to traditional painkillers or injection treatments, this technique offers a new hope for minimally invasive pain relief.

In summary, radiofrequency denervation provides a safe, non-surgical, and effective option for patients plagued by chronic joint pain.