Martin Christopher T, Haase Lucas, Lender Paul A, Polly David W
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
University of Minnesota Medical School, Minneapolis, Minnesota.
Int J Spine Surg. 2020 Feb 10;14(Suppl 1):20-29. doi: 10.14444/6072. eCollection 2020 Feb.
BACKGROUND: Fusion of the sacroiliac (SI) joint as a treatment for low back pain remains controversial. The purpose of this manuscript is to review the current literature and clinical outcomes of SI joint fusion surgery. METHODS: We conducted a literature review and included studies with the term "sacroiliac joint fusion" that had at least 12 months of clinical follow-up, reported on minimally invasive techniques, and included patient-reported outcome measures. RESULTS: Two approach types (dorsal and lateral) and numerous different implant manufacturers were identified. Most studies included level 4 data, with a small number of level 2 prospective cohort studies and 2 prospective level 1 studies. Every reviewed study reported clinical benefit in terms of improved pain scores or improvement in validated disability measures. Complication rates were low. CONCLUSIONS: Minimally invasive SI joint fusion provides clinically significant improvement in pain scores and disability in most patients, across multiple studies and implant manufacturers. LEVEL OF EVIDENCE: 5. CLINICAL RELEVANCE: Emerging evidence in support of SI joint fusion indicates that clinicians should examine the SI joint and include SI joint pain in their differential diagnosis for low back pain patients.
背景:骶髂关节融合术作为治疗腰痛的方法仍存在争议。本文的目的是回顾骶髂关节融合手术的当前文献和临床结果。 方法:我们进行了一项文献综述,纳入了标题中含有“骶髂关节融合”的研究,这些研究至少有12个月的临床随访,报道了微创技术,并纳入了患者报告的结局指标。 结果:确定了两种入路类型(后路和侧路)以及众多不同的植入物制造商。大多数研究纳入了4级数据,少数为2级前瞻性队列研究和2项1级前瞻性研究。每项纳入综述的研究均报告了在疼痛评分改善或经验证的残疾指标改善方面的临床获益。并发症发生率较低。 结论:在多项研究和不同植入物制造商中,微创骶髂关节融合术在大多数患者中可使疼痛评分和残疾状况得到临床上的显著改善。 证据级别:5级。 临床意义:支持骶髂关节融合术的新证据表明,临床医生应检查骶髂关节,并将骶髂关节疼痛纳入腰痛患者的鉴别诊断中。
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