Murakami Eiichi, Tanaka Yasuhisa, Aizawa Toshimi, Ishizuka Masato, Kokubun Shoichi
Department of Orthopaedic Surgery, Kamaishi Municipal Hospital, Kamaishi, Iwate, Japan.
J Orthop Sci. 2007 May;12(3):274-80. doi: 10.1007/s00776-007-1126-1. Epub 2007 May 31.
The sacroiliac joint (SIJ) can be a source of low back pain. Previous studies indicated that SIJ pain could originate from both the joint capsule and the posterior ligamentous tissues. It has not been clarified as to whether an intraarticular or periarticular injection procedure is more effective for this type of pain. The purpose of this study was to evaluate the effect of two injection procedures prospectively.
After a pain provocation test, an intraarticular injection of local anesthetic (2% lidocaine) was performed on the first 25 consecutive patients with SIJ pain and a periarticular injection on another 25. The periarticular injections were given to one or more sections of the posterior periarticular area of the SIJ and to another section in the extracranial portion. The effect of these injections was assessed using the "restriction of activities of daily life" scoring system from the Japanese Orthopaedic Association.
The periarticular injection was effective in all patients, but the intraarticular one was effective in only 9 of 25 patients. An additional periarticular injection was performed in 16 patients who experienced no effect from the initial intraarticular injection and was considered effective in all of them. The injection into the middle of the periarticular area was more effective for SIJ pain. The improvement rate after the periarticular injection was 96%, which was significantly higher than that after the intraarticular injection, which was 62%.
For patients with SIJ pain, periarticular injection is more effective and easier to perform than the intraarticular injection and should be tried initially.
骶髂关节（SIJ）可能是下腰痛的一个来源。先前的研究表明，骶髂关节疼痛可能源于关节囊和后韧带组织。对于这种类型的疼痛，关节内注射或关节周围注射哪种方法更有效尚未明确。本研究的目的是前瞻性地评估两种注射方法的效果。
在进行疼痛激发试验后，对连续25例骶髂关节疼痛患者进行关节内注射局部麻醉剂（2%利多卡因），对另外25例进行关节周围注射。关节周围注射针对骶髂关节后关节周围区域的一个或多个部位以及颅外部分的另一个部位。使用日本骨科协会的“日常生活活动受限”评分系统评估这些注射的效果。
关节周围注射对所有患者均有效，但关节内注射仅对25例患者中的9例有效。对16例初次关节内注射无效的患者进行了额外的关节周围注射，且认为对所有患者均有效。关节周围区域中部的注射对骶髂关节疼痛更有效。关节周围注射后的改善率为96%，显著高于关节内注射后的62%。
对于骶髂关节疼痛患者，关节周围注射比关节内注射更有效且更容易实施，应首先尝试。
