超声引导下闭孔神经关节支射频消融治疗慢性内侧髋关节疼痛：病例报告及文献研究

Ultrasound-Guided Radiofrequency Ablation of the Articular Branch of the Obturator Nerve for Chronic Medial Hip Pain: A Case Report and Literature Review

摘要: 背景：闭孔神经关节支射频消融术(Radiofrequency Ablation, RFA)是治疗非手术候选慢性内侧髋关节疼痛(Chronic Medial Hip Pain, CMHP)的常用手段，传统操作依赖透视或超声联合透视，单纯超声引导的相关研究匮乏。目的：评价超声引导下闭孔神经关节支RFA治疗CMHP的有效性与可行性。方法：纳入2例CMHP患者(1例股骨头缺血性坏死Ficat-Arlet IV期、1例髋关节骨关节炎Tonnis III期)，术前以1%利多卡因2 mL行诊断性阻滞，48小时后行超声引导下RFA，术后随访3个月。结果：术后3个月，2例患者的NRS评分分别从基线8分、7分降至2分、0分；WOMAC评分分别从92分、72分降至33分、6分；镇痛药物用量减少，1例完全停用，无并发症。结论：在本研究纳入的2例患者中，超声引导下闭孔神经关节支RFA初步显示出一定的精准性、微创性及无辐射优势，可能适用于非手术候选CMHP患者，或对缓解疼痛、改善功能具有潜在帮助，但该技术的有效性与安全性仍需大样本、长期随访研究进一步验证。目前结论仅为探索性发现，不能推广至更广泛的人群。

Abstract: Background: Radiofrequency ablation (RFA) of the articular branches of the obturator nerve is a common approach for treating chronic medial hip pain (CMHP) in patients who are not candidates for surgery. Traditional procedures rely on fluoroscopy or a combination of ultrasound and fluoroscopy, while studies on ultrasound-guided RFA alone are scarce. Objective: To evaluate the effectiveness and feasibility of ultrasound-guided RFA of the articular branches of the obturator nerve in treating CMHP. Methods: Two patients with CMHP (one with Ficat-Arlet stage IV avascular necrosis of the femoral head and one with Tonnis stage III hip osteoarthritis) were included. A diagnostic block was performed with 2 mL of 1% lidocaine before surgery. Ultrasound-guided RFA was carried out 48 hours later, and the patients were followed up for 3 months post-operatively. Results: At 3 months post-operatively, the NRS scores of the two patients decreased from 8 and 7 at baseline to 2 and 0, respectively. The WOMAC scores dropped from 92 and 72 to 33 and 6, respectively. The dosage of analgesic medications was reduced, with one patient completely discontinuing the use. No complications occurred. Conclusion: In the two patients included in this study, ultrasound-guided RFA of the articular branches of the obturator nerve initially showed certain advantages of accuracy, minimal invasiveness and no radiation. It may be suitable for non-surgical CMHP patients and may have potential help in relieving pain and improving function. However, the effectiveness and safety of this technology still need to be further verified by large-sample and long-term follow-up studies. At present, the conclusions are only exploratory findings and cannot be extended to a wider population.