射频消融用于关节软骨损伤的治疗研究进展

doi:10.3877/cma.j.issn.1674-134X.2022.05.010

软骨损伤普遍出现在正常人群中，严重影响了人们的日常生活与工作，然而软骨损伤仍是临床治疗的一个巨大挑战。机械清理、激光等传统软骨成形术由于其缺陷，无法满足临床应用的需求。射频软骨成形术作为一种更加安全、有效的技术，逐渐成为研究的热点。虽然基础研究表明射频产生的局部高温可能造成软骨细胞的死亡，但在长期的临床随访研究中，大量证据表明，相比机械清理软骨成形术，射频软骨成形术取得了更好的结果，并在一定程度上延缓了骨关节炎的进展。在使用的过程中，需要通过对射频使用时间、探头距离、灌洗液的流量和温度等方面的控制，来保证其安全性。本文通过简要介绍射频的历史、机制，综述了射频的临床应用结果，讨论如何更安全、有效地使用射频处理软骨损伤。

关键词: 软骨，关节, 射频治疗, 关节镜

Cartilage injury is common in normal population, which seriously affects people′s daily life and work. However, cartilage injury is still a great challenge in clinical treatment. The traditional chondroplasty, such as mechanical debridement and laser, cannot meet the needs of clinical demands due to their defects. Radiofrequency chondroplasty, as a safer and more effective technique, has gradually become a research hotspot. Although basic studies have shown that local heat generated by radiofrequency may contribute to chondrocyte death. In long-term clinical follow-up studies, there is substantial evidence that radiofrequency chondroplasty obtains better outcome and somewhat delays the progression of osteoarthritis compared to mechanical debridement. When using radiofrequency, clinicians need to control the use time, distance of the radiofrequency probe, flow and temperature of the lavage fluid to ensure its safety. This article briefly introduced the history and mechanism of radiofrequency, summarized the clinical application results of radiofrequency, and discussed how to use radiofrequency more safely and effectively.

Key words: Cartilage, articular, Radiofrequency therapy, Arthroscopy

表1 使用射频时间、功率设置、温度及灌洗液等因素对关节软骨的影响

影响因素	射频种类	实验标本	主要结果	参考文献
使用射频时间
0~50 s	双极	6例牛膝关节	至少需要处理20 s才能使软骨表面光滑	Peng等^[21]
5~40 s	单极和双极	42例人膝关节	15 s后关节软骨表面开始变得光滑	Lu等^[22]
功率设置
设置2 vs设置7；电凝vs消融	双极	12例猪膝关节	高功率设置下消融模式可以降低热辐射损伤	Wang等^[24]
20~110 W	单极	9例牛髌骨	在最低的消融模式设置(60W)下导致最小的细胞死亡深度	Lotto等^[25]
50 W vs 110 W	单极	13例牛髌骨	50 W功率设置和25 μm探头对软骨的组织效应最小	Mitchell等^[23]
温度影响(℃)
45、50、55	未报告	骨关节炎和非骨关节炎股骨关节软骨	在50 ℃时，软骨在处理后1周出现了一定的热应力恢复	Kaplan等^[27]
37~65	未报告	318例绵羊肱骨头全层软骨块	温度超过50~55 ℃后软骨细胞死亡比例迅速升高	Voss等^[28]
控制探头距离影响温度	双极	温度计测量温度	双极射频探头的温度均随距离的增加而降低	Kaplan等^[30]
控制灌洗液温度	单极	16例人膝关节	37 ℃灌洗液下可使软骨细胞死亡深度更小，表面更光滑	Lu等^[31]
控制灌洗液冲洗流量	双极	6例人踝关节标本	用较大的冲洗流量，可避免温度超过50 ℃	Ahrens等^[32]

表1 使用射频时间、功率设置、温度及灌洗液等因素对关节软骨的影响

影响因素	射频种类	实验标本	主要结果	参考文献
使用射频时间
0~50 s	双极	6例牛膝关节	至少需要处理20 s才能使软骨表面光滑	Peng等^[21]
5~40 s	单极和双极	42例人膝关节	15 s后关节软骨表面开始变得光滑	Lu等^[22]
功率设置
设置2 vs设置7；电凝vs消融	双极	12例猪膝关节	高功率设置下消融模式可以降低热辐射损伤	Wang等^[24]
20~110 W	单极	9例牛髌骨	在最低的消融模式设置(60W)下导致最小的细胞死亡深度	Lotto等^[25]
50 W vs 110 W	单极	13例牛髌骨	50 W功率设置和25 μm探头对软骨的组织效应最小	Mitchell等^[23]
温度影响(℃)
45、50、55	未报告	骨关节炎和非骨关节炎股骨关节软骨	在50 ℃时，软骨在处理后1周出现了一定的热应力恢复	Kaplan等^[27]
37~65	未报告	318例绵羊肱骨头全层软骨块	温度超过50~55 ℃后软骨细胞死亡比例迅速升高	Voss等^[28]
控制探头距离影响温度	双极	温度计测量温度	双极射频探头的温度均随距离的增加而降低	Kaplan等^[30]
控制灌洗液温度	单极	16例人膝关节	37 ℃灌洗液下可使软骨细胞死亡深度更小，表面更光滑	Lu等^[31]
控制灌洗液冲洗流量	双极	6例人踝关节标本	用较大的冲洗流量，可避免温度超过50 ℃	Ahrens等^[32]

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Research progress of radiofrequency ablation in treatment of articular cartilage injury

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Research progress of radiofrequency ablation in treatment of articular cartilage injury