骶髂关节关节内注射前后位投照法：一种新的 C 型臂引导方法的描述。

Sacroiliac Joint Intraarticular Injection in True Anteroposterior View: Description of a New C-Arm Guided Method.

机构信息

Department of Anesthesiology and Critical Care and Pain Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Department of Anesthesiology and Critical Care and Pain Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Pain Physician. 2018 Jan;21(1):61-66.

PMID:29357334

Abstract

BACKGROUND

The anatomic characteristics of the sacroiliac joint (SIJ) make it difficult to achieve intraarticular injection without radiologic guidance. The classic C-arm guided SIJ intervention technique is difficult. Here we describe a new and simple method for SIJ intraarticular intervention.

OBJECTIVE

This study aims to introduce a new, simple approach for SIJ intraarticular intervention.

STUDY DESIGN

An observational case series study.

SETTING

The study was conducted at an academic medical center in a major metropolitan city.

METHODS

This method of intervention was performed on 57 patients (a total of 73 joints) who were selected for diagnostic and therapeutic SIJ intervention. The procedure was done in anteroposterior (AP) view, without any C-arm angulation. The accuracy of the intraarticular injection was confirmed by using intraarticular contrast material. A numerical rating scale (NRS) score was recorded for each joint before and after the procedure; the number of x-ray exposures and number of attempts were recorded for each procedure as well.

RESULTS

Successful intraarticular contrast spread was obtained in all SIJs. The number of x-ray exposures was about 9 ± 3, and there was not a remarkable difference between cases according to gender of the patient (P = 0.1) or side of the joint (P = 0.2). In 5 cases, the first needle placement was not correct; there were no differences between gender (P = 0.4) and side of the joint (P = 0.4) regarding the first successful attempt. The NRS pain scores decreased in all of the patients more than 50% after the procedure; the pain scores were similar to the results of classic methods of intraarticular interventions with successful contrast spread, and there were no remarkable differences considering gender (P = 0.5) or side of the joint (P = 0.8).

LIMITATIONS

This is a very small, nonrandomized, and controlled study; further blinded clinical trials are needed to clarify the probable advantages of this method compared with conventional ones.

CONCLUSION

This observational study introduces a new and simple approach for SIJ intraarticular intervention, with a high success rate.

KEY WORDS

Low back pain, sacroiliac joint, C-arm, new technique, intraarticular, injection.

摘要

背景

骶髂关节 (SIJ) 的解剖学特征使得在没有影像学引导的情况下很难实现关节内注射。经典的 C 型臂引导的 SIJ 介入技术较为困难。在此，我们介绍一种新的简单的 SIJ 关节内介入方法。

目的

本研究旨在介绍一种新的简单的 SIJ 关节内介入方法。

研究设计

观察性病例系列研究。

设置

该研究在一个大城市的学术医疗中心进行。

方法

本介入方法共对 57 例（共 73 个关节）患者进行了诊断和治疗性 SIJ 介入，均选择该方法进行。该方法在前后位（AP）视图下进行，无需任何 C 型臂角度。通过关节内对比剂确认关节内注射的准确性。在介入前后，对每个关节进行数字评分量表（NRS）评分；并记录每次介入的 X 线曝光次数和尝试次数。

结果

所有 SIJ 均获得成功的关节内对比剂扩散。X 线曝光次数约为 9 ± 3，且根据患者性别（P = 0.1）或关节侧别（P = 0.2），曝光次数无显著差异。在 5 例中，首次进针位置不正确；首次成功尝试时，性别（P = 0.4）和关节侧别（P = 0.4）之间无差异。所有患者的 NRS 疼痛评分在介入后均降低超过 50%；疼痛评分与成功扩散对比剂的经典关节内介入方法相似，且考虑性别（P = 0.5）或关节侧别（P = 0.8），无显著差异。