jktoКафедра травматологии и ортопедииDepartment of Traumatology and Orthopaedics2226-2016ПРОФИЛЬ — 2С10.17238/issn2226-2016.2025.4.134-141jkto-55Research ArticleОРИГИНАЛЬНОЕ ИССЛЕДОВАНИЕORIGINAL RESEARCHЛазерная денервация против ПРП при поздних стадиях гонартроза: проспективное контролируемое исследованиеLaser denervation versus PRP for late-stage knee osteoarthritis: a prospective controlled studyЛычагинА. В.LychaginA. V.

Лычагин Алексей Владимирович - заведующий кафедрой, доктор медицинских наук, профессор кафедры травматологии ортопедии и хирургии катастроф, Первый МГМУ им. И.М. Сеченова (Сеченовский Университет), институт клинической медицины им. Н.В. Склифосовского.

119991, Москва

Alexey V. Lyachagin - Head of Department, Doctor of Medical Sciences, Professor of the Department of Traumatology, Orthopedics and Disaster Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), N.V. Sklifosovsky Institute of Clinical Medicine.

119991, Moscow

dr.lychagin@mail.ruЧерепановВ. Г.CherepanovV. G.

Черепанов Вадим Геннадьевич - доктор медицинских наук, профессор кафедры травматологии ортопедии и хирургии катастроф (Сеченовский Университет), Первый МГМУ им. И.М. Сеченова, институт клинической медицины им. Н.В. Склифосовского.

119991, Москва

Vadim G. Cherepanov - Doctor of Medical Sciences, Professor of the Department of Traumatology, Orthopedics and Disaster Surgery (Sechenov University), I.M. Sechenov First Moscow State Medical University, N.V. Sklifosovsky Institute of Clinical Medicine.

119991, Moscow

cvg_cherepanov@mail.ruКавалерскийГ. М.KavalerskyG. M.

Кавалерский Геннадий Михайлович - доктор медицинских наук, профессор кафедры травматологии ортопедии и хирургии катастроф (Сеченовский Университет), Первый МГМУ им. И.М. Сеченова, институт клинической медицины им. Н.В. Склифосовского.

119991, Москва

Gennady M. Kavalersky - Doctor of Medical Sciences, Professor of the Department of Traumatology, Orthopedics and Disaster Surgery (Sechenov University), I.M. Sechenov First Moscow State Medical University, N.V. Sklifosovsky Institute of Clinical Medicine.

119991, Moscow

gkavalerskiy@mail.ruГаркавиА. В.GarkaviA. V.

Гаркави Андрей Владимирович - доктор медицинских наук, профессор кафедры травматологии ортопедии и хирургии катастроф (Сеченовский Университет), Первый МГМУ им. И.М. Сеченова, институт клинической медицины им. Н.В. Склифосовского.

119991, Москва

Andrey V. Garkavi - Doctor of Medical Sciences, Professor of the Department of Traumatology, Orthopedics and Disaster Surgery (Sechenov University), I.M. Sechenov First Moscow State Medical University, N.V. Sklifosovsky Institute of Clinical Medicine.

119991, Moscow

avgar22@yandex.ruДрогинА. Р.DrogynA. R.

Дрогин Андрей Роальдович - кандидат медицинских наук, доцент кафедры травматологии ортопедии и хирургии катастроф, Первый МГМУ им. И.М. Сеченова (Сеченовский Университет), институт клинической медицины им. Н.В. Склифосовского.

119991, Москва

Andrey R. Drogin - Candidate of Medical Sciences, Associate Professor of the Department of Traumatology, Orthopedics and Disaster Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), N.V. Sklifosovsky Institute of Clinical Medicine.

119991, Moscow

a.drogin@yandex.ruВязанкинИ. А.VyazankinI. A.

Вязанкин Иван Антонович - кандидат медицинских наук, ассистент кафедры травматологии ортопедии и хирургии катастроф, Первый МГМУ им. И.М. Сеченова (Сеченовский Университет), институт клинической медицины им. Н.В. Склифосовского.

119991, Москва

Ivan A. Vyazankin - Candidate of Medical Sciences, Assistant of the Department of Traumatology, Orthopedics and Disaster Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), N.V. Sklifosovsky Institute of Clinical Medicine.

119991, Moscow

vzvzvzvan@mail.ruЕфремовА. Д.EfremovA. D.

Ефремов Артем Дмитриевич - аспирант кафедры травматологии ортопедии и хирургии катастроф, Первый МГМУ им. И.М. Сеченова (Сеченовский Университет), институт клинической медицины им. Н.В. Склифосовского.

119991, Москва

Artyom D. Efremov - Postgraduate Student of the Department of Traumatology, Orthopedics and Disaster Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), N.V. Sklifosovsky Institute of Clinical Medicine.

119991, Moscow

hdd.artyom@gmail.comСултанТ. Т.SultanT. T.

Султан Таля Талал - ординатор кафедры травматологии ортопедии и хирургии катастроф Первый МГМУ им. И.М. Сеченова (Сеченовский Университет), институт клинической медицины им. Н.В. Склифосовского.

119991, Москва

Talya T. Sultan - Resident Physician of the Department of Traumatology, Orthopedics and Disaster Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), N.V. Sklifosovsky Institute of Clinical Medicine.

119991, Moscow

talals@mail.ruУзаевА. А.UzaevA. A.

Узаев Ахмед Альвиевич - ординатор кафедры травматологии ортопедии и хирургии катастроф Первый МГМУ им. И.М. Сеченова (Сеченовский Университет), институт клинической медицины им. Н.В. Склифосовского.

119991, Москва

Ahmed A. Uzaev - Resident Physician of the Department of Traumatology, Orthopedics and Disaster Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), N.V. Sklifosovsky Institute of Clinical Medicine.

119991, Moscow

aauzarv@gmail.comНаддафЖ. Н.NaddafG. N.

Наддаф Жорж Насри - аспирант кафедры травматологии ортопедии и хирургии катастроф, Первый МГМУ им. И.М. Сеченова (Сеченовский Университет), институт клинической медицины им. Н.В. Склифосовского.

119991, Москва

George N. Naddaf - Postgraduate Student of the Department of Traumatology, Orthopedics and Disaster Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), N.V. Sklifosovsky Institute of Clinical Medicine.

119991, Moscow

georgenadaf@mail.ruФГАОУ ВО Первый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский Университет)РоссияFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russia (Sechenov University)Russian Federation20251303202604134141Copyright © Лычагин А.В., Черепанов В.Г., Кавалерский Г.М., Гаркави А.В., Дрогин А.Р., Вязанкин И.А., Ефремов А.Д., Султан Т.Т., Узаев А.А., Наддаф Ж.Н., 20262026Лычагин А.В., Черепанов В.Г., Кавалерский Г.М., Гаркави А.В., Дрогин А.Р., Вязанкин И.А., Ефремов А.Д., Султан Т.Т., Узаев А.А., Наддаф Ж.Н.Lychagin A.V., Cherepanov V.G., Kavalersky G.M., Garkavi A.V., Drogyn A.R., Vyazankin I.A., Efremov A.D., Sultan T.T., Uzaev A.A., Naddaf G.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jkto.moscow/jour/article/view/55Обоснование

Обоснование: Гонартроз является широко распространенным дегенеративным заболеванием, сопровождающимся хроническим болевым синдромом и снижением функции сустава. Сравнительная эффективность минимально инвазивных методов лечения, таких как инъекции обогащенной тромбоцитами плазмы (ПРП) и лазерная денервация геникулярных нервов (ЛДГН), у пациентов с поздними стадиями заболевания требует дальнейшего изучения.

Цель исследования

Цель исследования: Сравнить эффективность и безопасность внутрисуставного введения ПРП и ЛДГН в уменьшении боли и улучшении функции у пациентов с гонартрозом 3-4 стадии по Келлгрен-Лоуренс.

Материалы и методы

Материалы и методы: В проспективное рандомизированное исследование включен 31 пациент с гонартрозом. Участники были распределены на группу ПРП (n=16), получившую однократную внутрисуставную инъекцию аутологичной плазмы, и группу ЛДГН (n=15), где выполнена чрескожная лазерная денервация верхнемедиального, верхнелатерального и нижнемедиального геникулярных нервов под рентгенологическим и ультразвуковым контролем. Основными исходами были изменение показателей по Визуальной Аналоговой Шкале (ВАШ) и Индексу Остестри (ODI) через 2 недели, 3 и 6 месяцев.

Результаты

Результаты: В группе ЛДГН наблюдалось статистически значимо более выраженное снижение показателей ВАШ и ODI на всех контрольных точках по сравнению с группой ПРП. Серьезных нежелательных явлений не зарегистрировано ни в одной из групп.

Заключение

Заключение: Лазерная денервация геникулярных нервов обеспечивает превосходящее и устойчивое уменьшение боли и улучшение функциональной активности у пациентов с поздними стадиями гонартроза по сравнению с внутрисуставным введением ПРП в течение 6-месячного периода наблюдения, демонстрируя сопоставимый профиль безопасности.

Background

Background: Knee osteoarthritis (OA) is a prevalent degenerative joint disorder characterized by chronic pain and functional impairment. While minimally invasive treatments like platelet-rich plasma (PRP) injections and genicular nerve denervation are used for advanced stages, their comparative efficacy requires further investigation.

Objective

Objective: To compare the effectiveness and safety of intra-articular PRP injections and laser genicular nerve denervation (LGND) in patients with late-stage knee OA.

Methods

Methods: In this prospective, randomized, controlled trial, 31 patients with Kellgren-Lawrence grade 3-4 gonarthrosis were allocated to either a single intra-articular injection of autologous PRP (n=16) or a percutaneous LGND procedure (n=15) targeting the superomedial, superolateral, and inferomedial genicular nerves under combined x-ray and ultrasonographic guidance. The primary outcomes were the change from baseline in Visual Analog Scale (VAS) pain scores and the Oswestry Disability Index (ODI) at 2 weeks, 3 months, and 6 months post-procedure.

Results

Results: The LGND group demonstrated a statistically significant and greater reduction in both VAS and ODI scores at all follow-up intervals compared to the PRP group. No serious adverse events were reported in either group throughout the 6-month study period.

Conclusion

Conclusion: For patients with late-stage knee osteoarthritis, laser genicular nerve denervation provides superior and sustained pain relief and functional improvement over a single intra-articular PRP injection, with a comparable safety profile over six months.

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The authors declare that there are no conflicts of interest present.