膝动脉栓塞术治疗膝关节骨关节炎疼痛的研究进展

doi:10.3877/cma.j.issn.2095-5782.2026.02.003

膝关节骨关节炎（knee osteoarthritis, KOA）因其显著且持续的疼痛和功能障碍，已成为全球主要的致残因素之一。其疼痛的核心机制是机械损伤与关节退变触发“滑膜炎症-血管增生-神经支配异常-敏化”的恶性循环。传统保守治疗（如非甾体抗炎药、关节内注射）疗效有限，而全膝关节置换术（total knee arthroplasty, TKA）存在高风险和恢复期长等问题。膝动脉栓塞术（genicular artery embolization, GAE）作为一种新兴微创介入疗法，通过靶向栓塞膝关节异常新生血管，阻断滑膜炎症介导的神经血管耦联通路，从而达到缓解疼痛的目的。本文综述了KOA疼痛的病理生理机制、GAE的临床疗效、安全性及当前关键争议的最新循证依据，评估其在KOA阶梯治疗体系中的潜在价值与定位，并探讨未来研究方向。

关键词: 膝动脉栓塞术, 膝关节骨关节炎, 疼痛管理

Knee Osteoarthritis (KOA), characterized by significant and persistent pain and functional impairment, has emerged as a major global cause of disability. The core mechanism underlying its pain involves mechanical injury and joint degeneration triggering a vicious cycle of "synovitis-vascular proliferation-aberrant innervation-sensitization". Conventional conservative treatments (such as NSAIDs and intra-articular injections) offer limited efficacy, while Total Knee Arthroplasty (TKA) is constrained by its high-risk profile and prolonged recovery period. Genicular Artery Embolization (GAE), an emerging minimally invasive interventional therapy, aims to alleviate pain by selectively embolizing abnormal neovessels within the knee joint. This targeted approach disrupts the neurovascular coupling pathway mediated by synovial inflammation. This article systematically reviews the current evidence-based basis regarding the pathophysiology of KOA pain, GAE's clinical efficacy, safety profile, and key ongoing deliberations. It evaluates the potential value and positioning of GAE within the stepwise treatment framework for KOA and explores future research directions.

Key words: genicular artery embolization, knee osteoarthritis, pain management

图1 促血管生成与抗血管生成细胞因子、炎症生物标志物的平衡机制解析^[16] 注：Mechanical Damage，机械损伤；Synovitis，滑膜炎；Pro-inflammation，促炎症反应；Angiogenesis and Neoinnervation，血管新生与神经新生；Pro-angiogenic factors，促血管生成因子；VEGF，血管内皮生长因子；PGE2，前列腺素E2；IL-1，白细胞介素-1；PDGF，血小板衍生生长因子；Anti-angiogenic factors，抗血管生成因子；Chm-1，软骨调节素-1；INFγ，γ-干扰素；IL-4，白细胞介素-4；NO，一氧化氮。

图2 膝动脉栓塞术技术路径与操作要点示意图 A：正常膝动脉网；B：异常新生血管形成；C：病理新生血管栓塞术；D：栓塞术后异常新生血管闭塞。

图3 膝动脉栓塞术真实影像案例 3A：栓塞前图像，明显可见血管网密集；3B：栓塞后图像，异常增生血管闭塞，异常血流供应被阻断。

表1 膝动脉栓塞术治疗膝关节骨关节炎疼痛的研究证据汇总表

研究代码	研究类型	样本量	K–L分级	主要终点	再干预率	并发症率	不良反应发生率（随访时间）	参考文献
Landers S 2023	前瞻性单中心三盲RCT	58例（干预29例，对照30例）	2级 100%	KOOS疼痛评分变化	1.7%（对照1例6个月行TKA）	无严重并发症；轻微5例（穿刺瘀斑）	12个月：轻微8.5%，严重0%	[35]
van Zadelhoff TA 2024	前瞻性单中心双盲RCT	58膝（单侧）	1级6.9%，2级36.2%，3级56.9%	KOOS疼痛评分	0%	无严重并发症；GAE组轻微28例次，假手术组5例次	4个月：GAE组79.3%，假手术组17.2%	[41]
Gill SD 2023	前瞻性单中心队列	35膝（单侧）	2级33.3%，3级48.5%，4级18.2%	达标响应率	0%	无严重并发症；轻微2例次（瘀青、皮肤发红）	6个月：总6.1%	[25]
Sun C 2024	前瞻性单中心队列	37膝	轻中度1~2级28膝，重度3~4级9膝	VAS、WOMAC、临床成功率	3.0%（1例）	无严重并发症；轻微9例	12个月：轻微27.3%，严重0%	[26]
Lee SH 2019	前瞻性单中心队列	71膝	轻中度1~3级59膝，重度4级12膝	多时点VAS变化	7.3%（重度3例6个月行TKA）	无严重并发症；轻微10例	12个月：轻微14.1%，严重0%	[27]
Hindsø L 2024	前瞻性单中心单臂队列	17例（技术成功率85%）	1级12%，2级41%，3级47%	VAS、患者报告结局	0%	无严重并发症；轻微6例	6个月：轻微35.3%，严重0%	[28]
孙长浩 2022	前瞻性单中心单臂队列	23膝	2级21.7%，3级47.8%，4级30.1%	VAS、WOMAC	0%	无严重并发症；轻微7例	6个月：轻微41.2%，严重0%	[29]
Sapoval M 2024	前瞻性多中心开放队列	23膝	3级45%，4级55%	术后1个月严重不良事件	0%	严重1例（造影剂肾损伤）；轻微2例	1个月：严重4.5%，轻微9.1%	[33]
Taheri Amin A 2025	前瞻性单中心单臂队列	43膝（单侧）	1级21%，2级37%，3级42%	KOOS疼痛评分变化	11.6%（5例4~11个月行TKA）	轻微4例（短暂皮肤发红）	12个月：总9.3%	[36]
Hindsø L 2024	前瞻性单中心单臂队列	17膝	2级12%，3级41%，4级47%	滑膜炎评分	0%	无并发症	6个月：轻微0%，严重0%	[38]
Wang B 2023	前瞻性单中心队列	24膝	1级20.8%，2级58.3%，3级20.8%	骨髓病变、VAS	13.6%（3例行TKA）	无严重并发症；轻微7例次	6个月：轻微31.8%，严重0%	[39]
Little MW 2024	前瞻性单中心单臂队列	40例（技术成功率87%）	1级10.9%，2级41.3%，3级47.8%	VAS、KOOS	22.5%（9例18个月行TKA）	严重1例（腘窝DVT）；轻微6例次	2年：轻微15%，严重2.5%	[40]
Bagla S 2020	前瞻性多中心单臂队列	20膝（单侧）	1级10%，2级50%，3级40%	VAS、WOMAC	0%	无严重并发症；轻微16例次	6个月：轻微80%，严重0%	[42]
Min J 2023	回顾性单中心队列	97膝	未报告	VAS、技术/临床成功率	未报告	无严重并发症；轻微59例次	6个月：轻微60.8%，严重0%	[34]
Dablan A 2024	回顾性单中心单臂队列	35膝	2级57%，3级29%，4级14%	滑膜炎半定量评分	0%	无严重并发症；轻微6例次	3个月：轻微17.1%，严重0%	[37]

表1 膝动脉栓塞术治疗膝关节骨关节炎疼痛的研究证据汇总表

研究代码	研究类型	样本量	K–L分级	主要终点	再干预率	并发症率	不良反应发生率（随访时间）	参考文献
Landers S 2023	前瞻性单中心三盲RCT	58例（干预29例，对照30例）	2级 100%	KOOS疼痛评分变化	1.7%（对照1例6个月行TKA）	无严重并发症；轻微5例（穿刺瘀斑）	12个月：轻微8.5%，严重0%	[35]
van Zadelhoff TA 2024	前瞻性单中心双盲RCT	58膝（单侧）	1级6.9%，2级36.2%，3级56.9%	KOOS疼痛评分	0%	无严重并发症；GAE组轻微28例次，假手术组5例次	4个月：GAE组79.3%，假手术组17.2%	[41]
Gill SD 2023	前瞻性单中心队列	35膝（单侧）	2级33.3%，3级48.5%，4级18.2%	达标响应率	0%	无严重并发症；轻微2例次（瘀青、皮肤发红）	6个月：总6.1%	[25]
Sun C 2024	前瞻性单中心队列	37膝	轻中度1~2级28膝，重度3~4级9膝	VAS、WOMAC、临床成功率	3.0%（1例）	无严重并发症；轻微9例	12个月：轻微27.3%，严重0%	[26]
Lee SH 2019	前瞻性单中心队列	71膝	轻中度1~3级59膝，重度4级12膝	多时点VAS变化	7.3%（重度3例6个月行TKA）	无严重并发症；轻微10例	12个月：轻微14.1%，严重0%	[27]
Hindsø L 2024	前瞻性单中心单臂队列	17例（技术成功率85%）	1级12%，2级41%，3级47%	VAS、患者报告结局	0%	无严重并发症；轻微6例	6个月：轻微35.3%，严重0%	[28]
孙长浩 2022	前瞻性单中心单臂队列	23膝	2级21.7%，3级47.8%，4级30.1%	VAS、WOMAC	0%	无严重并发症；轻微7例	6个月：轻微41.2%，严重0%	[29]
Sapoval M 2024	前瞻性多中心开放队列	23膝	3级45%，4级55%	术后1个月严重不良事件	0%	严重1例（造影剂肾损伤）；轻微2例	1个月：严重4.5%，轻微9.1%	[33]
Taheri Amin A 2025	前瞻性单中心单臂队列	43膝（单侧）	1级21%，2级37%，3级42%	KOOS疼痛评分变化	11.6%（5例4~11个月行TKA）	轻微4例（短暂皮肤发红）	12个月：总9.3%	[36]
Hindsø L 2024	前瞻性单中心单臂队列	17膝	2级12%，3级41%，4级47%	滑膜炎评分	0%	无并发症	6个月：轻微0%，严重0%	[38]
Wang B 2023	前瞻性单中心队列	24膝	1级20.8%，2级58.3%，3级20.8%	骨髓病变、VAS	13.6%（3例行TKA）	无严重并发症；轻微7例次	6个月：轻微31.8%，严重0%	[39]
Little MW 2024	前瞻性单中心单臂队列	40例（技术成功率87%）	1级10.9%，2级41.3%，3级47.8%	VAS、KOOS	22.5%（9例18个月行TKA）	严重1例（腘窝DVT）；轻微6例次	2年：轻微15%，严重2.5%	[40]
Bagla S 2020	前瞻性多中心单臂队列	20膝（单侧）	1级10%，2级50%，3级40%	VAS、WOMAC	0%	无严重并发症；轻微16例次	6个月：轻微80%，严重0%	[42]
Min J 2023	回顾性单中心队列	97膝	未报告	VAS、技术/临床成功率	未报告	无严重并发症；轻微59例次	6个月：轻微60.8%，严重0%	[34]
Dablan A 2024	回顾性单中心单臂队列	35膝	2级57%，3级29%，4级14%	滑膜炎半定量评分	0%	无严重并发症；轻微6例次	3个月：轻微17.1%，严重0%	[37]

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Genicular Artery Embolization: Recent Advances in Managing Knee Osteoarthritis Pain

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Genicular Artery Embolization: Recent Advances in Managing Knee Osteoarthritis Pain