Lewinnek G E, Warfield C A
Clin Orthop Relat Res. 1986 Dec(213):216-22.
Recognizing that not all patients with low back pain have lumbar disc disease, the authors began to inject facet joints in June 1982 and have experience now with 21 patients, each injected under fluoroscopic control with a mixture of local anesthetic and steroid. One technical problem occurred when large osteophytes blocked access to the facet joints. Otherwise, there were no complications and minimal morbidity. Most patients (15 of 20; 75%) had an initial response, but a much smaller number (six of 18 followed more than three months; 33%) had a lasting response. Repeat injections, when done, always led to temporary improvement but rarely to lasting relief (one of five; 20%). Three factors characterized the patients: a negative screening examination for other causes of back pain or sciatica; back pain with tenderness localized over one or more facet joints; and radiologic changes of degenerative joint disease within the facet joints. Facet joint disease may be a significant cause of low back pain. The above three criteria are useful in clinical identification of patients with this problem. Facet joint injections play an important role in the diagnosis and treatment of low back pain.
由于认识到并非所有下腰痛患者都患有腰椎间盘疾病，作者于1982年6月开始对小关节进行注射，目前已对21例患者进行了治疗，每例均在透视控制下注射局部麻醉剂和类固醇的混合物。当大的骨赘阻碍进入小关节时出现了一个技术问题。除此之外，没有并发症且发病率极低。大多数患者（20例中的15例；75%）有初始反应，但持续有反应的患者数量要少得多（18例随访超过三个月的患者中的6例；33%）。重复注射时，总能带来暂时改善，但很少能带来持久缓解（5例中的1例；20%）。患者有三个特征：对其他引起背痛或坐骨神经痛的原因筛查呈阴性；背痛且压痛局限于一个或多个小关节；小关节内有退行性关节病的放射学改变。小关节疾病可能是下腰痛的一个重要原因。上述三个标准有助于临床识别有此问题的患者。小关节注射在下腰痛的诊断和治疗中起重要作用。
