关节突关节注射与全身皮质类固醇治疗腰痛的疗效比较：一项随机对照试验。

Effect of facet joint injection versus systemic steroids in low back pain: a randomized controlled trial.

机构信息

From the Division of Rheumatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.

出版信息

Spine (Phila Pa 1976). 2013 Nov 1;38(23):1995-2002. doi: 10.1097/BRS.0b013e3182a76df1.

DOI:10.1097/BRS.0b013e3182a76df1

PMID:23921331

Abstract

STUDY DESIGN

Randomized clinical trial.

OBJECTIVE

To compare the effectiveness of facet joint injection versus systemic steroid in patients with a diagnosis of facet joint syndrome.

SUMMARY OF BACKGROUND DATA

The term facet joint syndrome has been used to define back pain originating from the facet joints. Treatment is mainly conservative, although interventions, including intra-articular injections and medial branch nerve blocks are used to manage facet-mediated pain. Several studies have evaluated the effectiveness of these interventions. Results of facet joint injection, however, are conflicting.

METHODS

Sixty subjects with a diagnosis of facet joint syndrome were enrolled in the study. They were randomized into experimental and control groups. The experimental group was administered with intra-articular injection of 6 lumbar facet joints with triamcinolone hexacetonide; the control group was administered with triamcinolone acetonide intramuscular injection of 6 lumbar paravertebral points. Visits were taken at baseline and at 1, 4, 12, and 24 weeks after interventions. Outcome measures were used: pain visual analogue scale, pain visual analogue scale during extension of the spine, Likert scale, improvement percentage scale, Roland-Morris, 36-Item Short Form Health Survey, and accountability of medications taken.Homogeneity was tested using the Student t, Pearson χ, and Mann-Whitney tests. Analysis of variance was used to analyze differences in the groups over time and the Student t test to analyze differences between groups at each time evaluation.

RESULTS

The groups were similar at baseline. Comparisons between the groups showed, in analysis of variance analysis, an improvement in the experimental group regarding diclofenac intake and quality of life, in the "role physical" profile, assessed by 36-Item Short Form Health Survey.In the analysis at each time point, an improvement in the experimental group was also found in the Roland-Morris questionnaire, in the improvement percentage scale and in the response to treatment, assessed by the Likert scale.

CONCLUSION

Both treatments were effective, with a slight superiority of the intra-articular injection of steroids over intramuscular injection.

摘要

研究设计

随机临床试验。

目的

比较关节突关节注射与全身皮质类固醇治疗关节突综合征患者的疗效。

背景资料概要

关节突综合征这一术语用于定义起源于关节突关节的背痛。治疗主要是保守的，尽管包括关节内注射和内侧支神经阻滞在内的干预措施用于治疗关节突介导的疼痛。已经有几项研究评估了这些干预措施的有效性。然而，关节突关节注射的结果存在争议。

方法

本研究纳入了 60 例关节突综合征患者。他们被随机分为实验组和对照组。实验组接受 6 个腰椎关节突关节曲安奈德六乙酸注射；对照组接受 6 个腰椎旁椎点曲安奈德丙酮注射。在干预后 1、4、12 和 24 周进行随访。使用以下指标进行评估：疼痛视觉模拟评分、脊柱伸展时的疼痛视觉模拟评分、Likert 量表、改善百分比量表、Roland-Morris 量表、36 项简明健康状况调查问卷、药物使用情况。使用学生 t 检验、皮尔逊 χ 检验和曼-惠特尼检验测试同质性。方差分析用于分析组间随时间的差异，学生 t 检验用于分析每个时间点组间的差异。