动脉栓塞治疗膝骨关节炎的研究进展

doi:10.3877/cma.j.issn.1674-134X.2025.06.015

膝骨关节炎（KOA）是一种膝关节功能受损和结构破坏的慢性退行性疾病，发病率逐年升高。目前，早中期KOA多采用保守治疗，晚期KOA则多选用手术治疗，但这些治疗方式均存在一定的不足。膝关节动脉栓塞（GAE）作为KOA治疗的热点，具有减轻疼痛显著、创伤小、严重并发症发生率低等优点，临床应用前景广泛。本文从GAE治疗KOA相关机制、操作要点、临床疗效及安全性等方面进行综述，为临床实践提供参考。

关键词: 骨关节炎，膝, 栓塞, 治疗结果

Knee osteoarthritis (KOA) is a chronic degenerative disease characterized by impaired knee joint function and structural damage, with an increasing incidence. Currently, conservative treatment is often used for early to mid-stage KOA, while surgical intervention is considered for advanced stages. However, these treatments have certain limitations. Genicular artery embolization (GAE) has emerged as a promising treatment for KOA, offering significant pain relief, minimal invasiveness, and a low incidence of severe complications. As research on GAE continues to grow, this article reviewed the mechanisms, procedural details, clinical efficacy, and safety of GAE in treating KOA, providing a reference for clinical practice.

Key words: Osteoarthritis, knee, Embolism, Treatment outcome

图1 膝关节血管解剖示意图注：A-股浅动脉；B-膝降动脉；C-腘动脉；D-膝降动脉关节支；E-膝降动脉隐支；F-膝上外侧动脉；G-膝上内侧动脉；H-膝中动脉；I-膝下外侧动脉；J-膝下内侧动脉；K-胫前返动脉；L-胫前动脉；M-胫腓干

Figure 1 Schematic diagram of the arterial anatomy around the kneeNote: A-superficial femoral artery; B-descending genicular artery; C-popliteal artery; D-articular branch of descending genicular artery; E-saphenous branch of descending genicular artery; F-superior lateral genicular artery; G-superior medial genicular artery; H-mMiddle genicular artery; I-inferior lateral genicular artery; J -inferior medial genicular artery; K-anterior tibial recurrent artery; L-anterior tibial artery; M-tibio-peroneal trunk

图2 亚胺培南/西司他丁钠栓塞前后右膝关节膝上内侧动脉血管造影。图A为栓塞前血管造影，（圆圈内）示膝上内侧动脉新生血管区的异常染色；图B为栓塞后血管造影，（圆圈内示）膝关节内侧关节面及股骨内上髁处异常染色消失

Figure 2 Angiographies before and after embolization of the superior medial genicular artery in right knee using imipenem and cilastatin sodium. A is angiography before embolization, showing abnormal staining in neovascular area of superior medial genicular artery(the circle region)；B is angiography after embolization, showing disappearance of abnormal staining in medial articular surface and medial epicondyle of femur (the circle region)

图3 亚胺培南/西司他丁钠栓塞前后右膝关节膝降内侧动脉血管造影。图A为栓塞前血管造影，（圆圈内）示膝降动脉的新生血管区的异常染色（圈中所示）；图B为栓塞后血管造影，（圆圈内）示膝关节内侧关节面异常染色消失

Figure 3 Angiographies before and after embolization of the descending medial genicular artery in right knee using imipenem and cilastatin sodium. A is angiography before embolization, showing abnormal staining in neovascular area of the descending genicular artery(the circle region)；B is angiography after embolization, showing disappearance of abnormal staining in medial articular surface (the circle region)

表1 不同栓塞材料的临床研究对比

Table 1 Comparison of clinical studies with different embolic agents

栓塞剂	材料性质	研究类型	患者（例）	膝关节数（个）	年龄（岁）	性别（男/女）	随访时间（月）	严重度（Kellgren-Lawrence分级）
Embozene微球^[19]	永久性	回顾性研究	14	20	73.14	3/11	24	2~4
Optisphere颗粒^[18]	暂时性	随机对照研究	14	14	63.9	2/12	12	1~3
Embosphere微球^[20]	永久性	前瞻性研究	21	21	67.2	3 /18	3	1~3
IPM/CS ^[21]	暂时性	前瞻性研究	10	未提及	62.2	4/6	24	1~2
碘化油^[22]	暂时性	前瞻性研究	22	未提及	66.0	9/13	3	3~4
明胶海绵颗粒^[23]	暂时性	回顾性研究	71	97	64.0	17/54	6	未提及
聚乙烯醇^[24]	永久性	前瞻性研究	33	37	66.6	未提及	12	2~3

表1 不同栓塞材料的临床研究对比

Table 1 Comparison of clinical studies with different embolic agents

栓塞剂	材料性质	研究类型	患者（例）	膝关节数（个）	年龄（岁）	性别（男/女）	随访时间（月）	严重度（Kellgren-Lawrence分级）
Embozene微球^[19]	永久性	回顾性研究	14	20	73.14	3/11	24	2~4
Optisphere颗粒^[18]	暂时性	随机对照研究	14	14	63.9	2/12	12	1~3
Embosphere微球^[20]	永久性	前瞻性研究	21	21	67.2	3 /18	3	1~3
IPM/CS ^[21]	暂时性	前瞻性研究	10	未提及	62.2	4/6	24	1~2
碘化油^[22]	暂时性	前瞻性研究	22	未提及	66.0	9/13	3	3~4
明胶海绵颗粒^[23]	暂时性	回顾性研究	71	97	64.0	17/54	6	未提及
聚乙烯醇^[24]	永久性	前瞻性研究	33	37	66.6	未提及	12	2~3

[1]	胡银华, 薛龙. 中国中老年人症状性膝骨关节炎的发病率及危险因素[J/OL]. 中华关节外科杂志（电子版）, 2023, 17（4）: 470-478.
[2]	Garstang SV, Stitik TP. Osteoarthritis: epidemiology, risk factors, and pathophysiology[J]. Am J Phys Med Rehabil, 2006, 85（11 suppl）: S2-11; quizS12-4.
[3]	孟利民, 王茂强, 付金鑫. 关节滑膜动脉栓塞术治疗骨关节炎进展[J]. 中华放射学杂志, 2024, 58（10）: 1087-1091.
[4]	MacDonald IJ, Liu SC, Su CM, et al. Implications of angiogenesis involvement in arthritis[J/OL]. Int J Mol Sci, 2018, 19（7）: E2012. DOI: 10.3390/ijms19072012.
[5]	Mapp PI, Walsh DA. Mechanisms and targets of angiogenesis and nerve growth in osteoarthritis[J]. Nat Rev Rheumatol, 2012, 8（7）: 390-398.
[6]	Heller DB, Beggin AE, Lam AH, et al. Geniculate artery embolization: role in knee hemarthrosis and osteoarthritis[J]. Radiographics, 2022, 42（1）: 289-301.
[7]	Ro DH, Jang MJ, Koh J, et al. Mechanism of action of genicular artery embolization in a rabbit model of knee osteoarthritis[J]. Eur Radiol, 2023, 33（1）: 125-134.
[8]	Kamisako A, Ikoma A, Koike M, et al. Transcatheter arterial embolization of abnormal neovessels in a swine model of knee arthritis[J]. Knee, 2022, 36: 20-26.
[9]	Uflacker AB, Keefe N, Bruner ET, et al. Assessing the effects of geniculate artery embolization in a nonsurgical animal model of osteoarthritis[J]. J Vasc Interv Radiol, 2022, 33（9）: 1073-1082. e2.
[10]	Talaie R, Torkian P, Golzarian J. Knee and shoulder vascular anatomy[J/OL]. Tech Vasc Interv Radiol, 2023, 26（1）: 100877. DOI: 10.1016/j.tvir.2022.100877.
[11]	Liu S, Swilling D, Morris EM, et al. Genicular artery embolization: areview of essential anatomic considerations[J]. J Vasc Interv Radiol, 2024, 35（4）: 487-496. e6.
[12]	Ahmed O, Epelboym Y, Haskal ZJ, et al. Society of interventional radiology research reporting standards for genicular artery embolization[J]. J Vasc Interv Radiol, 2024, 35（8）: 1097-1103.
[13]	Kılıçkesmez Ö, Dablan A, Güzelbey T, et al. Comparative analysis of transpedal and transfemoral access during genicular artery embolization for knee osteoarthritis[J]. Cardiovasc Intervent Radiol, 2024, 47（10）: 1335-1345.
[14]	Sterbis E, Casadaban L. Genicular artery embolization technique[J/OL]. Tech Vasc Interv Radiol, 2023, 26（1）: 100878. DOI: 10.1016/j.tvir.2022.100878.
[15]	Cusumano LR, Callese TE, Redwood K, et al. Added value of cone-beam CT to identify arterial supply during genicular artery embolization for knee osteoarthritis[J]. J Vasc Interv Radiol, 2023, 34（11）: 1861-1867.
[16]	Guzelbey T, Dablan A, Arslan MF, et al. Comparing technical success and clinical outcomes of macrocatheter versus microcatheter in genicular artery embolization for knee osteoarthritis[J/OL]. Eur J Radiol, 2024, 177: 111582. DOI: 10.1016/j.ejrad.2024.111582.
[17]	Casadaban LC, Mandell JC, Epelboym Y. Genicular artery embolization for osteoarthritis related knee pain: asystematic review and qualitative analysis of clinical outcomes[J]. Cardiovasc Intervent Radiol, 2021, 44（1）: 1-9.
[18]	Gorsi U, Singh D, Kang M, et al. Safety and efficacy of genicular artery embolization for the treatment of knee pain secondary to osteoarthritis-initial Indian experience[J]. Indian J Radiol Imaging, 2023, 34（1）: 37-43.
[19]	Bhatia S, Jalaeian H, Kumar J, et al. Two-year outcomes comparing Embosphere® microspheres versus Imipenem Cilastatin for genicular artery embolization in patients with moderate to severe knee osteoarthritis[J]. Knee, 2023, 41: 38-47.
[20]	Bagla S, Piechowiak R, Sajan A, et al. Multicenter randomized sham controlled study of genicular artery embolization for knee pain secondary to osteoarthritis[J]. J Vasc Interv Radiol, 2022, 33（1）: 2-10. e2.
[21]	Lee SH, Hwang JH, Kim DH, et al. Clinical outcomes of transcatheter arterial embolisation for chronic knee pain: mild-to-moderate versus severe knee osteoarthritis[J]. Cardiovasc Intervent Radiol, 2019, 42（11）: 1530-1536.
[22]	Sapoval M, Querub C, Pereira H, et al. Genicular artery embolization for knee osteoarthritis: results of the lipioJoint-1 trial[J]. Diagn Interv Imaging, 2024, 105（4）: 144-150.
[23]	Min J, Park SW, Hwang JH, et al. Evaluating the safety and effectiveness of quick-soluble gelatin sponge particles for genicular artery embolization for chronic knee pain associated with osteoarthritis[J]. J Vasc Interv Radiol, 2023, 34（11）: 1868-1874.
[24]	Sun C, Chen Y, Gao Z, et al. Genicular artery embolization for the treatment of knee pain secondary to mild to severe knee osteoarthritis: One year clinical outcomes[J/OL]. Eur J Radiol, 2024, 175: 111443. DOI: 10.1016/j.ejrad.2024.111443.
[25]	李永奇, 王刚刚, 王禹基, 等. 膝动脉栓塞治疗膝骨关节炎继发性疼痛的疗效与安全性荟萃分析[J]. 中华医学杂志, 2024, 104（45）: 4162-4170.
[26]	Padia SA, Genshaft S, Blumstein G, et al. Genicular artery embolization for the treatment of symptomatic knee osteoarthritis[J/OL]. JB JS Open Access, 2021, 6（4）: e21. 00085. DOI: 10.2106/JBJS.OA.21.00085.
[27]	Cusumano LR, Sparks HD, Masterson KE, et al. Genicular artery embolization for treatment of symptomatic knee osteoarthritis: 2-year outcomes from a prospective IDE trial[J]. J Vasc Interv Radiol, 2024, 35（12）: 1768-1775.
[28]	Bagla S, Piechowiak R, Hartman T, et al. Genicular artery embolization for the treatment of knee pain secondary to osteoarthritis[J]. J Vasc Interv Radiol, 2020, 31（7）: 1096-1102.
[29]	孙长浩, 高知玲, 林坤, 等. 选择性膝动脉栓塞术治疗膝骨关节炎继发性疼痛的疗效分析[J]. 中华医学杂志, 2022, 102（11）: 795-800.
[30]	林坤, 孙长浩, 竺红, 等. 膝动脉栓塞治疗中重度膝骨关节炎继发性疼痛的可行性及近期疗效分析[J]. 中华放射学杂志, 2021, 55（12）: 1318-1323.
[31]	van Zadelhoff TA, Bos PK, Moelker A, et al. Genicular artery embolisation versus sham embolisation for symptomatic osteoarthritis of the knee: a randomised controlled trial[J/OL]. BMJ Open, 2024, 14（10）: e087047. DOI: 10.1136/bmjopen-2024-087047.
[32]	Landers S, Hely R, Hely A, et al. Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial[J]. Bone Jt Open, 2023, 4（3）: 158-167.
[33]	Okuno Y, Korchi AM, Shinjo T, et al. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment[J]. J Vasc Interv Radiol, 2017, 28（7）: 995-1002.
[34]	Wang B, Tai TW, Liang KW, et al. Short-term effects of genicular artery embolization on symptoms and bone marrow abnormalities in patients with refractory knee osteoarthritis[J]. J Vasc Interv Radiol, 2023, 34（7）: 1126-1134. e2.
[35]	van Zadelhoff TA, Okuno Y, Bos PK, et al. Association between baseline osteoarthritic features on MR imaging and clinical outcome after genicular artery embolization for knee osteoarthritis[J]. J Vasc Interv Radiol, 2021, 32（4）: 497-503.
[36]	Choi JW, Ro DH, Chae HD, et al. The value of preprocedural MR imaging in genicular artery embolization for patients with osteoarthritic knee pain[J]. J Vasc Interv Radiol, 2020, 31（12）: 2043-2050.
[37]	Torkian P, Golzarian J, Chalian M, et al. Osteoarthritis-related knee pain treated with genicular artery embolization: a systematic review and meta-analysis[J/OL]. Orthop J Sports Med, 2021, 9（7）: 23259671211021356. DOI: 10.1177/23259671211021356.

[1]	徐留海, 王颉, 田志鹏, 黄晶, 曾勇, 王茂朋, 刘丛钊, 周游. 影响盘状半月板损伤术后疗效的危险因素研究[J/OL]. 中华关节外科杂志(电子版), 2025, 19(05): 528-534.
[2]	胡娜娜, 刘雪情, 尹诗九. 跗骨窦螺钉术后矫正器对青少年平足症的影响[J/OL]. 中华关节外科杂志(电子版), 2025, 19(05): 543-548.
[3]	董书恒, 孙庆, 屈一鸣. 椎体成形术联合抗骨质疏松药物治疗骨质疏松性椎体骨折[J/OL]. 中华关节外科杂志(电子版), 2025, 19(05): 586-596.
[4]	姜玉峰, 曹建春, 黄天一, 李炳辉, 杨立民, 吕国忠, 曹烨民, 徐旭英, 阙华发, 韩春茂, 魏在荣, 王肖南, 黄跃生. 拔毒生肌散对糖尿病足溃疡治疗效果的多中心随机平行对照研究[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(06): 490-498.
[5]	杨浩, 王春岭, 席少华, 尹素然. 富血小板血浆联合关节镜手术治疗膝骨关节炎的疗效分析[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(06): 499-504.
[6]	侯承素, 张野, 王健, 史敬存, 殷玉兰, 王磊. 巨大骨化纤维瘤合并动脉瘤样骨囊肿1例[J/OL]. 中华口腔医学研究杂志(电子版), 2025, 19(06): 400-404.
[7]	陈系东, 王绍闯, 赵何伟, 王硕, 袁维栋. 高龄BCLC B期肝癌患者常规TACE术后急性肝功能恶化的危险因素研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 689-692.
[8]	李婷婷, 李宏羽, 吴孟航. 肝动脉灌注化疗在不可切除肝细胞癌中的应用进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 705-708.
[9]	徐其银, 韩尚志. 术前结合术后营养支持对直肠癌患者康复的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(05): 543-546.
[10]	吴菲, 袁媛, 何凡, 杜秋丽, 窦婷, 阮剑. 超声定位下冷循环射频消融术治疗甲状腺良性结节的疗效及预后分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(05): 562-565.
[11]	刘建鹏, 严丽燕, 冯少婷, 黄鹏, 梁开丽, 方鸿飞. D-二聚体、肌钙蛋白及氨基末端脑利钠肽前体在急性肺栓塞预后中的临床意义研究[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(06): 1019-1022.
[12]	王利皓, 罗世超, 唐强, 尚栋良, 段少博, 卢冰, 李海, 薛飞. 仑伐替尼和PD-1抑制剂预处理联合TACE序贯治疗CNLC分期Ⅲ期肝癌疗效及安全性[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 868-874.
[13]	朱康, 郑潇, 张磊, 于娜. 超声造影及血清标志物检测对肝癌介入术后微血管侵犯及复发的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(05): 474-479.
[14]	李姁, 冯中秋. HBV相关原发性肝癌患者经导管动脉化疗栓塞术后严重腹痛预测模型的构建及验证[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(05): 480-485.
[15]	卢剑峰, 王亚云, 王佳宁, 苗丹. 心源性卒中危险因素的研究进展[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(06): 550-554.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Research progress on arterial embolization in treatment of knee osteoarthritis

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Research progress on arterial embolization in treatment of knee osteoarthritis