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Investigation of genicular neurotomy of the knee: MRI characterization of anatomy and implications for intervention.

膝关节膝部神经切断术的研究: 解剖学的MRI特征及其对干预的意义。

  • 影响因子:1.26
  • DOI:10.1016/j.clinimag.2019.09.006
  • 作者列表:"Kwon SS","Chazen JL","Kishore S","Habibi BA","Chi M","Rand E","Lowder R","Singh JR
  • 发表时间:2020-01-01
Abstract

BACKGROUND:Genicular nerve block and subsequent radiofrequency neurotomy (RFN) has emerged as a novel intervention and alternative for total knee arthroplasty in patients with refractory pain from knee osteoarthritis (OA). To our knowledge, there is no cited report correlating the accuracy of localizing the genicular nerves using bony landmarks on magnetic resonance imaging (MRI). OBJECTIVES:To quantify the proximity of superomedial genicular nerve (SMGN), superolateral genicular nerve (SLGN), and inferomedial genicular nerve (IMGN) from a target point. The target point was an intersection marked by a line parallel to the diaphysis and a separate line parallel to the metaphyseal flare along the cortical surfaces of both the femur and tibia. DESIGN:Retrospective chart review. PATIENTS:A total of 25 de-identified knee MRIs were reviewed. METHODS:The coronal proton density fat suppressed sequence was used for identification and localization of the SLGN, SMGN, and IMGN. The neurovascular bundles were traced from posterior location along their origin as they wrap around the distal diaphysis. The nerve locations were determined by consensus measurements performed by two board-certified radiologists with certificates of added qualification in neuroradiology and interventional radiology. The proximity of each respective genicular nerves was measured by drawing a perpendicular line from each genicular nerve to the height of the target point. All measurements were taken on the mid-coronal view at the point of maximal epiphyseal flare. MAIN OUTCOME MEASUREMENTS:Positive values indicated the location of the neurovascular bundle to be superior to the target point. Negative values indicated the location of the neurovascular bundle to be inferior to the target point. RESULTS:The distance between our target point and the inferior border of SLGN ranged from -3 mm to 6 mm. Twenty-three out of 25 (92%) SLGN lied exactly at or above our target intersection. The distance between our target point and the inferior border of SMGN ranged from -1 mm to 2 mm with twenty-two out of 25 (88%) SMGN lied exactly at or above our target point. The distance between our target point and the superior border of IMGN ranged from 0 mm to 3 mm with all (100%) IMGN lying exactly at or above the target point. CONCLUSION:The intersection of the femoral diaphyseal shaft to a line along the metaphyseal flare and the intersection of the tibial diaphyseal shaft to a line along the medial metaphyseal can be used as a target point to localize the genicular nerves with close proximity.

摘要

背景: 膝状神经阻滞和随后的射频神经切断术 (RFN) 已经成为全膝关节置换术治疗膝关节骨性关节炎 (OA) 顽固性疼痛患者的一种新型干预和替代方法。据我们所知,在磁共振成像 (MRI) 上没有引用与使用骨性标志定位膝神经的准确性相关的报告。 目的: 量化膝上神经 (SMGN) 、膝上外侧神经 (SLGN) 和膝下神经 (IMGN) 从靶点的接近程度。靶点是沿着股骨和胫骨皮质表面平行于骨干的线和平行于干骺端耀斑的单独线标记的交叉点。 设计: 回顾性图表回顾。 患者: 共回顾了 25 例去鉴别的膝关节mri。 方法: 采用冠状位质子密度脂肪抑制序列对SLGN、SMGN和IMGN进行鉴定和定位。神经血管束在缠绕远端骨干时,沿其起源从后部追踪。神经位置由两名具有神经放射学和介入放射学附加资格证书的委员会认证放射科医生进行共识测量确定。通过绘制从每个膝神经到目标点高度的垂直线来测量各个膝神经的接近程度。所有测量均在最大骨骺耀斑点的中冠状视图上进行。 主要结局测量: 阳性值表示神经血管束的位置优于目标点。负值表示神经血管束的位置低于目标点。 结果: 我们的目标点与SLGN下缘的距离为-3mm ~ 6mm。25 (92%) 个SLGN中有 23 个恰好位于我们的目标交叉点或上方。我们的目标点与SMGN的下边界之间的距离范围为-1 毫米至 2 毫米,22 出 2 5 (88%) SMGN恰好位于或高于我们的目标点。我们的目标点与IMGN上缘之间的距离为 0mm ~ 3mm,所有 (1 0 0%) IMGN恰好位于目标点或以上。 结论: 股骨骨干轴与干骺端耀斑线的交点和胫骨骨干轴与内侧干骺端线的交点可以作为定位膝部的目标点。接近的神经。

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发表时间:2020-01-01
DOI:10.1002/acr.23824
作者列表:["Chen SK","Liao KP","Liu J","Kim SC"]

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DOI:10.1002/acr.23827
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