Schütz Uwe, Grob Dieter
Schulthess Clinic, Zurich, Switzerland.
Acta Orthop Belg. 2006 Jun;72(3):296-308.
The purpose of this retrospective study was to evaluate the clinical and radiological outcome of bilateral sacroiliac joint (SIJ) fusion, using a new technique, in patients with a chronic SIJ syndrome. Seventeen patients with chronic low back pain, with a positive response to specific diagnostic tests for the SIJ, were considered candidates for bilateral sacroiliac fusion. The surgical indication was based on the results of local anaesthetic joint infiltration, temporary external fixation or bone scan. Ten patients had had previous surgery on the lumbar spine. Bilateral posterior SIJ fusion was performed with internal fixation and decortication of the sacroiliac joint, using a separate approach to each joint. Local bone grafting was performed. At the time of follow-up (on average 39 months after surgery), 3 patients reported moderate or absent pain, 8 marked pain and 6 severe pain. Seven patients showed a symptomatic non-union; union occurred in only 6 cases. Eighteen percent of the patients were satisfied, but in the other 82% the results were not acceptable. Reoperation was performed in 65% of the patients. Our results with bilateral posterior SIJ fusion were disappointing, which may be related with difficulties in patient selection, as well as with surgical technique. Better diagnostic procedures and possibly other surgical techniques might provide more predictable results, but this remains to be demonstrated.
这项回顾性研究的目的是评估采用一种新技术对慢性骶髂关节综合征患者进行双侧骶髂关节融合术的临床和影像学结果。17例慢性下腰痛患者，对骶髂关节特异性诊断试验呈阳性反应，被视为双侧骶髂关节融合术的候选者。手术指征基于局部麻醉关节浸润、临时外固定或骨扫描的结果。10例患者曾接受过腰椎手术。采用对每个关节单独的入路，通过内固定和骶髂关节去皮质进行双侧骶髂关节后融合术，并进行局部植骨。在随访时（平均术后39个月），3例患者报告中度疼痛或无疼痛，8例有明显疼痛，6例有严重疼痛。7例患者出现有症状的骨不连；仅6例实现骨愈合。18%的患者感到满意，但其他82%的患者对结果不满意。65%的患者进行了再次手术。我们双侧骶髂关节后融合术的结果令人失望，这可能与患者选择困难以及手术技术有关。更好的诊断方法以及可能的其他手术技术可能会提供更可预测的结果，但这仍有待证实。
