经足背动脉入路膝动脉栓塞术治疗慢性膝骨关节炎疼痛的可行性、安全性与临床结局
单中心前瞻性质量改进项目纳入69例（110膝）慢性膝骨关节炎（KL分级≥2）患者，经足背动脉入路行膝动脉栓塞术，技术成功率100%，无入路部位并发症，仅2.7%出现自限性不良反应。随访6个月VAS与WOMAC均显著下降（p<0.05），72.5%患者达到VAS MCID、71.0%达到WOMAC MCID，提示该入路可行、安全且能带来有临床意义的疼痛与功能改善。
要点
- 经足背动脉入路GAE技术成功率100%，无入路部位并发症，可作为替代入路选择。
- 术后6个月VAS由基线8.05降至4.25、WOMAC由72.9降至40.99，疼痛与功能持续改善。
- 约七成患者达到MCID（VAS≥2分或WOMAC≥20分改善），临床获益具有意义。
关键影像表现/征象
- KL分级分布为3级51.82%、4级24.55%，提示纳入以中重度骨关节炎为主。
- 经足背动脉入路成功率为97.3%，技术成功率为100%。
- 平均手术时间30.24±16.24 min，透视时间10.17±6.25 min，对比剂用量87.59±25.6 mL。
- 无入路部位并发症，3例（2.7%）出现自限性不良反应。
- VAS由基线8.05±1.77降至1、3、6个月的4.78、4.25、4.25；WOMAC由基线72.9±16.3降至42.55、38.58、40.99（p<0.05）。
诊断标准与关键数值
- MCID阈值定义为VAS降低≥2分或WOMAC改善≥20分。
- 随访期间患者层面50/69（72.5%）达到VAS MCID，49/69（71.0%）达到WOMAC MCID。
- 纳入标准为慢性膝骨关节炎且Kellgren-Lawrence分级≥2。
- 不良事件按介入放射学会（SIR）标准分类。
临床应用与阅片要点
- 经足背动脉入路可作为GAE的替代入路，技术成功率高且无入路部位并发症。
- 术后随访可采用VAS与WOMAC评估疼痛与功能，并以MCID（VAS≥2分或WOMAC≥20分）判断临床获益。
- 本组以KL 3–4级中重度骨关节炎为主，疗效与安全性数据可为此类患者提供参考。
局限性
- 单中心、前瞻性质量改进项目，非随机对照设计。
- 样本量69例（110膝），随访仅至6个月。
- 作者指出需更大规模多中心对照研究进一步验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVE: To assess the feasibility, safety, and clinical outcomes of genicular artery embolization (GAE) via transpedal approach for the treatment of knee pain secondary to chronic knee osteoarthritis (OA).
MATERIALS AND METHODS: This single-center, prospective quality improvement (QI) initiative measured clinical outcomes and patient experience of 69 patients (110 knees) who underwent genicular artery embolization between August 2024 and May 2025. The project was conducted in accordance with institutional quality improvement policies, and all patients provided informed consent for the procedure. Patients had chronic knee osteoarthritis with Kellgren-Lawrence (KL) grade ≥ 2. Pain and mobility were assessed using Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and at 1, 3, and 6 months. Minimal clinically important difference (MCID) thresholds were defined as a ≥ 2-point VAS reduction or ≥ 20-point WOMAC improvement. Adverse events were classified by Society of Interventional Radiology (SIR) standards.
RESULTS: Sixty-nine patients (110 knees; mean age 72.6 ± 7.43 years, 62% female, mean BMI 33.48 ± 7.78) underwent GAE. Kellgren Lawrence (KL) distribution was 51.82% grade 3 and 24.55% grade 4. Transpedal access was successful in 97.3%, and technical success was achieved in 100% of cases. Mean procedure time was 30.24 ± 16.24 min, fluoroscopy time 10.17 ± 6.25 min, and contrast volume 87.59 ± 25.6 mL. No access site complications occurred. Three patients (2.7%) had self-limiting adverse reactions. VAS decreased from 8.05 ± 1.77 at baseline to 4.78, 4.25, and 4.25 at 1, 3, and 6 months; WOMAC decreased from 72.9 ± 16.3 at baseline and at 42.55, 38.58, and 40.99 at respective timepoints (p < 0.05). At the patient level, 50/69 patients (72.5%) achieved VAS MCID and 49/69 patients (71.0%) achieved WOMAC MCID during follow-up.
CONCLUSION: Transpedal GAE was feasible, safe, and associated with clinically meaningful improvements in pain and function through six months in this single-center cohort. These findings support further study of transpedal access as an alternative approach for GAE. Larger-scale multicenter comparative studies are warranted.
引用
- Ratcliffe JA, Foulard G, Khullar P, et al. The evolution of therapy for chronic osteoarthritic knee pain: Feasibility, safety and clinical outcomes of transpedal access for genicular artery embolization. Eur J Radiol. 2026. PMID: 42172738. doi:10.1016/j.ejrad.2026.112935
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。