诊断性注射能否预测足踝关节融合术的结果？
Can diagnostic injections predict the outcome in foot and ankle arthrodesis?
机构信息
Department of Orthopaedics, Maartenskliniek Woerden, Woerden, The Netherlands.
出版信息
BMC Musculoskelet Disord. 2014 Jan 9;15:11. doi: 10.1186/1471-2474-15-11.
BACKGROUND
Intra-articular anesthetic drug injections are claimed to confirm the localization of the pain in order to treat the pain. The aim of the present study was to evaluate whether a positive effect of injection could be indicative for a successful outcome of future arthrodesis.
METHODS
74 Patients underwent fluoroscopically guided and contrast confirmed anesthetic joint injections for diagnostic reasons. Before and after injection, pain was measured by use of the Visual Analogue Scale (VAS) in rest and after exercise. Pain reduction was expressed as delta VAS (dVAS). Also, the Foot Function Index (FFI) was obtained. Based on the effect of the diagnostic injection and various clinical factors, patients were advised a conservative treatment (conservative group, n = 34) or an arthrodesis of the affected joint (operative group, n = 40). After a median follow-up period of 3.6 years (range 2.1 to 4.3 years) patients were again invited to complete the FFI and VAS in rest and after exercise. For data-analysis purposes the patients were assigned to four different groups, based on the result of injection and the occurrence of surgery. Wilcoxon signed rank tests and Mann Whitney U tests were used for statistical analysis.
RESULTS
Based on the analysis of the four groups we found that surgery, irrespective of the presence of pain reduction after injection, was related to improvement of VAS and FFI. Patients with conservative treatment always showed worse VAS and FFI scores, even when previous injections showed an improvement of VAS.
CONCLUSIONS
Fluoroscopically-guided anesthetic injections of the supposed painful foot-ankle joint seem not to be indicative for a successful outcome of an arthrodesis of the affected joint. However, the sole occurrence of surgery shows a significant difference in VAS and FFI scores, where conservative treatment does not. The local hospital review board granted permission for this study. Ethical approval was not required for this study.
背景
关节内麻醉药物注射据称可确定疼痛的定位，以治疗疼痛。本研究的目的是评估注射的阳性效果是否可指示未来关节融合术的成功结果。
方法
74 例患者因诊断目的接受了荧光引导和对比确认的麻醉关节注射。在注射前后，使用视觉模拟量表（VAS）测量休息时和运动后的疼痛。疼痛减轻表示为 delta VAS（dVAS）。还获得了足部功能指数（FFI）。根据诊断性注射的效果和各种临床因素，建议患者接受保守治疗（保守组，n = 34）或受累关节的融合术（手术组，n = 40）。在中位数为 3.6 年（范围 2.1 至 4.3 年）的随访后，患者再次被邀请完成 FFI 和 VAS 在休息时和运动后。为了数据分析目的，根据注射结果和手术发生情况，将患者分为四组。使用 Wilcoxon 符号秩检验和 Mann-Whitney U 检验进行统计分析。
结果
根据对四组的分析，我们发现手术与 VAS 和 FFI 的改善相关，而与注射后疼痛减轻的存在无关。接受保守治疗的患者始终表现出更差的 VAS 和 FFI 评分，即使先前的注射显示 VAS 有所改善。
结论
荧光引导下对疑似疼痛的足踝关节进行麻醉注射似乎不能指示受累关节融合术的成功结果。然而，仅手术的发生就显示出 VAS 和 FFI 评分的显著差异，而保守治疗则没有。当地医院审查委员会批准了这项研究。这项研究不需要伦理批准。
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