Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands.
Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
J Orthop Surg Res. 2022 Dec 28;17(1):570. doi: 10.1186/s13018-022-03466-x.
For a substantial part of patients with chronic low back pain, the origin is located in the sacroiliac joint (SIJ). Minimally invasive sacroiliac joint fusion (MISJF) is increasingly being implemented as a treatment option in SIJ dysfunction. Despite remaining controversy, evidence continues to increase. This study evaluates the clinical results and safety of MISJF in a double-center consecutive case series in patients with SIJ dysfunction over a one-year observation period.
SIJ complaints were diagnosed after history taking, physical examination and least a 50% reduction of SIJ pain 30-60 min following image-guided injection. Primary outcome measures were patient reported outcome measurements (PROMs), consisting of Visual Analogue Scale (VAS) pain score and EuroQol 5-dimensions 3-levels (EQ-5D-3L). Patients' perspectives on the effects of surgery were collected through questionnaires. Secondary outcome measures were implant positioning and (serious) adverse events ((S)AE's).
A total of 29 patients were included. In 44.8% of patients, SIJ dysfunction was of postpartum origin. The mean VAS-pain score improved from 7.83 (± 1.71) to 4.97 (± 2.63) postoperatively (p < 0.001). EQ-5D-3L score improved from 0.266 (± 0.129) to 0.499 (± 0.260) postoperatively (p < 0.001). Opioid consumption decreased from 44.8 to 24.1% postoperatively (p = 0.026). In 13.7% of patients, an (S)AE occurred.
MISJF appears to be an effective and safe procedure in this cohort. Statistically significant and clinically relevant improvements in pain and quality of life were observed one-year postoperatively. Future studies should focus on the long-term outcomes to further evaluate the safety and effectiveness of MISJF.
对于相当一部分慢性下腰痛患者来说,其根源位于骶髂关节(SIJ)。作为 SIJ 功能障碍的一种治疗选择,微创骶髂关节融合术(MISJF)的应用越来越多。尽管仍存在争议,但证据不断增加。本研究通过双中心连续病例系列研究,在为期一年的观察期内评估 MISJF 在 SIJ 功能障碍患者中的临床疗效和安全性。
通过病史询问、体格检查和至少在图像引导注射后 30-60 分钟 SIJ 疼痛减轻 50%以上,诊断为 SIJ 疼痛。主要观察指标为患者报告的结果测量(PROMs),包括视觉模拟量表(VAS)疼痛评分和欧洲五维健康量表 3 级(EQ-5D-3L)。通过问卷调查收集患者对手术效果的看法。次要观察指标为植入物的定位和(严重)不良事件(SAE)。
共纳入 29 例患者。44.8%的患者 SIJ 功能障碍为产后原因。术后 VAS 疼痛评分从 7.83(±1.71)改善至 4.97(±2.63)(p<0.001)。EQ-5D-3L 评分从 0.266(±0.129)改善至 0.499(±0.260)(p<0.001)。术后阿片类药物使用率从 44.8%降至 24.1%(p=0.026)。13.7%的患者发生(SAE)。
在本队列中,MISJF 似乎是一种有效且安全的方法。术后一年观察到疼痛和生活质量有统计学意义和临床意义的改善。未来的研究应侧重于长期结果,以进一步评估 MISJF 的安全性和有效性。