Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
EvergreenHealth, Kirkland, Washington, USA.
Pain Med. 2018 Oct 1;19(10):1924-1943. doi: 10.1093/pm/pnx329.
To compare the percentage of sacral lateral branches (LBs) that would be captured if lesions were created by seven current sacroiliac joint (SIJ) radiofrequency ablation (RFA) techniques: three monopolar and four bipolar.
Cadaveric fluoroscopy study.
Anatomy and surgical skills laboratories.
Forty cadaveric SIJs.
LBs were exposed, radiopaque wires were sutured to LBs, and anterior-posterior fluoroscopic images through the S1 superior endplate were obtained. Lesions that would be created by 17 versions of seven current SIJ RFA techniques were mapped on the fluoroscopic images. These 17 versions were compared: 1) percentage of LBs that would be captured; 2) percentage of SIJ specimens in which 100% of LBs would be captured; and 3) percentage of LBs that would not be captured at each level (S1-S4).
Both the mean LB and 100% capture rates were greater for the bipolar techniques (93.4-99.7% and 62.5-97.5%, respectively) than for the monopolar techniques (49.6-99.1% and 2.5-92.5%, respectively) evaluated. For the bipolar techniques, 1.5-29.2% of LBs would not be captured at S1 and 0% at S2-S4 vs 0-29.2% at S1-S4 for the cooled monopolar techniques vs 36.9-100% at S1-S4 for the conventional monopolar technique.
The findings suggest that, if lesions were created, the RFA needle placement locations of the bipolar techniques evaluated may be capable of capturing all LBs, but those of the current monopolar techniques evaluated may not. Future in vivo imaging studies are required to compare the lesion morphology generated by different SIJ RFA techniques and correlate the findings with clinical outcomes.
比较 7 种当前骶髂关节（SIJ）射频消融（RFA）技术创建病变时会捕获的骶外侧支（LB）的百分比：3 种单极和 4 种双极。
尸体透视研究。
解剖和手术技能实验室。
40 个尸体骶髂关节。
暴露 LB，将不透射线的线缝合到 LB 上，并通过 S1 上终板获得前后透视图像。在透视图像上绘制了 7 种当前 SIJ RFA 技术的 17 种版本会创建的病变。比较了这 17 种版本：1）会捕获的 LB 百分比；2）100％的 LB 会被捕获的 SIJ 标本百分比；3）每个水平（S1-S4）无法捕获的 LB 百分比。
与单极技术（分别为 49.6-99.1％和 2.5-92.5％）相比，双极技术的平均 LB 和 100％捕获率更高（分别为 93.4-99.7％和 62.5-97.5％）。对于双极技术，1.5-29.2％的 LB 在 S1 处无法捕获，而在 S2-S4 处无法捕获 0％，而对于冷却的单极技术，在 S1-S4 处无法捕获 0-29.2％，而对于常规单极技术，在 S1-S4 处可捕获 36.9-100％。
研究结果表明，如果创建了病变，评估的双极技术的 RFA 针放置位置可能能够捕获所有 LB，但评估的当前单极技术的针放置位置可能无法捕获。需要进行未来的体内影像学研究，以比较不同的 SIJ RFA 技术生成的病变形态，并将这些发现与临床结果相关联。
