Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Anaesthesiology, Max Super Speciality Hospital, Mohali, Punjab, India.
Pain Pract. 2017 Jul;17(6):782-791. doi: 10.1111/papr.12526. Epub 2016 Dec 1.
Despite widespread use of steroids to treat sacroiliac joint (SIJ) pain, their duration of pain reduction is short. Platelet-rich plasma (PRP) can potentially enhance tissue healing and may have a longer-lasting effect on pain.
To assess the efficacy and safety of PRP compared with methylprednisolone in ultrasound-guided SIJ injection for low back pain.
Prospective randomized open blinded end point (PROBE) study.
Forty patients with chronic low back pain diagnosed with SIJ pathology were randomly allocated into 2 groups. Group S received 1.5 mL of methylprednisolone (40 mg/mL) and 1.5 mL of 2% lidocaine with 0.5 mL of saline, while Group P received 3 mL of leukocyte-free PRP with 0.5 mL of calcium chloride into ultrasound-guided SIJ injection. Visual analog scale (VAS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, Short Form (SF-12) Health Survey scores, and complications (if any) were evaluated at 2 weeks, 4 weeks, 6 weeks, and 3 months.
Intensity of pain was significantly lower in Group P at 6 weeks (median [interquartile range (IQR)] = 1 [1 to 1] vs. 3.5 [2 to 5]; P = 0.0004) and 3 months (Median [IQR] = 1 [1 to 3] vs. 5 [3 to 5]; P = 0.0002) as compared to Group S. The efficacy of steroid injection was reduced to only 25% at 3 months in Group S, while it was 90% in Group P. A strong association was observed in patients receiving PRP and showing a reduction of VAS ≥ 50% from baseline when other factors were controlled. The MODQ and SF-12 scores were improved initially for up to 4 weeks but deteriorated further at 3 months in Group S, while both the scores improved gradually for up to 3 months in Group P.
The intra-articular PRP injection is an effective treatment modality in low back pain involving SIJ.
尽管广泛使用类固醇治疗骶髂关节（SIJ）疼痛，但它们减轻疼痛的持续时间很短。富含血小板的血浆（PRP）有可能增强组织愈合，并可能对疼痛产生更长时间的影响。
评估超声引导下 SIJ 注射 PRP 与甲泼尼龙治疗慢性下腰痛的疗效和安全性。
前瞻性随机开放盲终点（PROBE）研究。
将 40 例慢性下腰痛诊断为 SIJ 病变的患者随机分为 2 组。S 组接受 1.5 mL 甲泼尼龙（40 mg/mL）和 1.5 mL 2%利多卡因加 0.5 mL 生理盐水，而 P 组接受 3 mL 白细胞游离 PRP 加 0.5 mL 氯化钙超声引导下 SIJ 注射。在 2 周、4 周、6 周和 3 个月评估视觉模拟评分（VAS）、改良 Oswestry 残疾问卷（MODQ）、简明健康调查量表（SF-12）评分和并发症（如有）。
与 S 组相比，P 组在 6 周（中位数[四分位距（IQR）] = 1 [1 到 1] 比 3.5 [2 到 5]；P = 0.0004）和 3 个月（中位数[IQR] = 1 [1 到 3] 比 5 [3 到 5]；P = 0.0002）时疼痛强度显著降低。S 组在 3 个月时类固醇注射的疗效降低至仅 25%，而 P 组为 90%。在接受 PRP 治疗且 VAS 从基线降低≥50%的患者中观察到强烈关联，当控制其他因素时。MODQ 和 SF-12 评分在最初的 4 周内有所改善，但在 S 组中在 3 个月时进一步恶化，而在 P 组中这两个评分在 3 个月内逐渐改善。
关节内 PRP 注射是治疗涉及 SIJ 的慢性下腰痛的有效治疗方法。
