Cohen Steven P, Strassels Scott A, Kurihara Connie, Crooks Matthew T, Erdek Michael A, Forsythe Akara, Marcuson Matthew
Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Reg Anesth Pain Med. 2009 May-Jun;34(3):206-14. doi: 10.1097/AAP.0b013e3181958f4b.
Sacroiliac (SI) joint pain is a challenging condition characterized by limited treatment options. Recently, numerous studies have reported excellent intermediate-term outcomes after lateral-branch radiofrequency (RF) denervation, but these studies are characterized by wide variability in technique, selection criteria, and patient characteristics. The purpose of this study was to determine whether any demographic or clinical variables can be used to predict SI joint RF denervation outcome.
Seventy-seven patients with refractory, injection-confirmed SI joint pain underwent SI joint denervation at 2 academic institutions. A composite binary variable "successful" outcome was predefined as greater than 50% reduction in pain lasting at least 6 months coupled with a positive global perceived effect. Secondary outcome measures included Oswestry Disability Index scores, medication reduction, and retention on active duty for soldiers. Factors retrospectively evaluated for their association with outcome included demographic variables, duration of pain, opioid usage, pain referral pattern, physical examination signs, number of blocks and percentage of pain relief after SI joint injection, prognostic lateral-branch blocks, previous surgery, levels lesioned, RF technique, disability status, and coexisting medical conditions.
Forty patients (52%) obtained a positive outcome. In multivariate analysis, preprocedure pain intensity, age older than 65 years, and pain radiating below the knee were significant predictors of failure. A trend was noted whereby patients receiving regular opioid therapy were more likely to experience a negative outcome. The use of cooled, rather than conventional RF, was associated with a higher percentage of positive outcomes.
Whereas several factors were found to influence outcome, no single clinical variable reliably predicted treatment results. The use of more stringent selection criteria was not associated with better outcomes.
骶髂关节疼痛是一种治疗选择有限、颇具挑战性的病症。近期，众多研究报告了经皮侧支射频去神经术具有良好的中期疗效，但这些研究在技术、选择标准和患者特征方面存在很大差异。本研究的目的是确定是否有任何人口统计学或临床变量可用于预测骶髂关节射频去神经术的疗效。
77例经注射确诊为顽固性骶髂关节疼痛的患者在两家学术机构接受了骶髂关节去神经术。将复合二元变量“成功”结局预先定义为疼痛减轻超过50%且持续至少6个月，同时伴有积极的整体感知效果。次要结局指标包括Oswestry功能障碍指数评分、药物用量减少以及士兵的现役保留情况。对与结局相关的因素进行回顾性评估，包括人口统计学变量、疼痛持续时间、阿片类药物使用情况、疼痛放射模式、体格检查体征、骶髂关节注射后的阻滞次数和疼痛缓解百分比、预后性侧支阻滞、既往手术、病变节段、射频技术、残疾状况以及并存的医疗状况。
40例患者（52%）获得了阳性结局。在多变量分析中，术前疼痛强度、年龄大于65岁以及疼痛放射至膝关节以下是失败的显著预测因素。有一个趋势是，接受常规阿片类药物治疗的患者更有可能出现阴性结局。使用冷射频而非传统射频与更高比例的阳性结局相关。
虽然发现有几个因素会影响结局，但没有单一的临床变量能可靠地预测治疗结果。使用更严格的选择标准与更好的结局无关。
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