Sun Hui-Hui, Zhuang Su-Yang, Hong Xin, Xie Xin-Hui, Zhu Lei, Wu Xiao-Tao
The Spine Center, Department of Orthopedics, Zhong-Da Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, China Department of Surgery, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany.
Medicine (Baltimore). 2018 Feb;97(6):e9809. doi: 10.1097/MD.0000000000009809.
Cooled radiofrequency procedure is a novel minimally invasive surgical technique and has been occasionally utilized in managing chronic sacroiliac joint (SIJ) pain. A meta-analysis was conducted to systematically assess the efficacy and safety of using cooled radiofrequency in treating patients with chronic SIJ pain in terms of pain and disability relief, patients' satisfaction degree as well as complications.
Studies of using cooled radiofrequency procedure in managing SIJ pain were retrieved from Medline and Web of Science according to inclusion and exclusion criteria. Quality evaluation was conducted using Cochrane collaboration tool for randomized controlled trials and MINORS quality assessment for noncomparative trials. Statistics were managed using Review Manager 5.3.
Totally 7 studies with 240 eligible patients were enrolled. The overall pooled results demonstrated that pain intensity decreased significantly after cooled radiofrequency procedure compared with that measured before treatment. The mean difference (MD) was 3.81 [95% confidence intervals (95% CIs): 3.29-4.33, P < .001] and 3.78 (95% CIs: 3.31-4.25, P < .001) as measured by the Numerical Rating Scale (NRS) and Visual Analog Scale (VAS), respectively. Disability also relieved significantly after treatment compared with that measured before treatment. The MD was 18.2 (95% CIs: 12.22-24.17, P < .001) as measured by the Oswestry Disability Index (ODI). Seventy-two percent of the patients presented positive results as measured by the Global Perceived Effect (GPE). The OR was 0.01 (95% CIs: 0.00-0.05, P < .001). Only mild complications were observed in the 7 studies, including transient hip pain, soreness, and numbness.
Cooled radiofrequency procedure can significantly relieve pain and disability with no severe complications, and majority of patients are satisfied with this technique. Thus, it is safe and effective to use this procedure in managing patients with chronic SIJ pain. More high-quality and large-scale randomized controlled trials (RCTs) are required to validate our findings.
The sample size of the included studies was small and various heterogeneity existed.
冷循环射频治疗是一种新型的微创手术技术，偶尔用于治疗慢性骶髂关节（SIJ）疼痛。本荟萃分析旨在系统评估冷循环射频治疗慢性SIJ疼痛患者在缓解疼痛和功能障碍、患者满意度以及并发症方面的疗效和安全性。
根据纳入和排除标准，从Medline和科学网检索使用冷循环射频治疗SIJ疼痛的研究。采用Cochrane协作工具对随机对照试验进行质量评估，采用MINORS质量评估对非对照试验进行质量评估。使用Review Manager 5.3进行统计分析。
共纳入7项研究，240例符合条件的患者。总体汇总结果表明，与治疗前相比，冷循环射频治疗后疼痛强度显著降低。采用数字评分量表（NRS）和视觉模拟量表（VAS）测量，平均差值（MD）分别为3为3.81[95%置信区间（95%CI）：3.29 - 4.33，P<0.001]和3.78（95%CI：3.31 - 4.25，P<0.001）。与治疗前相比，治疗后功能障碍也显著缓解。采用Oswestry功能障碍指数（ODI）测量，MD为18.2（95%CI：12.22 - 24.17，P<0.001）。72%的患者根据整体疗效评估（GPE）显示为阳性结果。优势比（OR）为0.01（95%CI：0.00 - 0.05，P<0.001）。在这7项研究中仅观察到轻微并发症，包括短暂性髋关节疼痛、酸痛和麻木。
冷循环射频治疗可显著缓解疼痛和功能障碍，无严重并发症，且大多数患者对该技术满意。因此，使用该方法治疗慢性SIJ疼痛患者是安全有效的。需要更多高质量、大规模的随机对照试验（RCT）来验证我们的研究结果。
纳入研究的样本量较小，且存在各种异质性。
