Whang Peter G, Patel Vikas, Duhon Bradley, Sturesson Bengt, Cher Daniel, Carlton Reckling W, Capobianco Robyn, Polly David
Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA.
Department of Orthopedics and Spine Surgery, University of Colorado, Aurora, CO, USA.
Int J Spine Surg. 2023 Dec 26;17(6):794-808. doi: 10.14444/8543.
Sacroiliac (SI) joint fusion is increasingly used to treat chronic SI joint pain. Multiple surgical approaches are now available.
Data abstraction and random effects meta-analysis of safety and efficacy outcomes from published patient cohorts. Patient-reported outcomes (PROs) and safety measures were stratified by surgical technique: transiliac, including lateral transiliac (LTI) and posterolateral transiliac (PLTI), and posterior interpositional (PI) procedures.
Fifty-seven cohorts of 2851 patients were identified, including 43 cohorts (2126 patients) for LTI, 6 cohorts (228 patients) for PLTI, and 8 cohorts (497 patients) for PI procedures. Randomized trials were only available for LTI. PROs were available for pain (numeric rating scale) in 57 cohorts (2851 patients) and disability (Oswestry Disability Index [ODI]) in 37 cohorts (1978 patients).All studies with PROs showed improvement from baseline after surgery. Meta-analytic improvements in pain scores were highest for LTI (4.8 points [0-10 scale]), slightly lower for PLTI (4.2 points), and lowest for PI procedures (3.8 points, = 0.1533). Mean improvements in ODI scores were highest for LTI (25.9 points), lowest for PLTI procedures (6.8 points), and intermediate for PI (16.3 points, = 0.0095).For safety outcomes, acute symptomatic implant malposition was 0.43% for LTI, 0% for PLTI, and 0.2% for PI procedures. Wound infection was reported in 0.15% of LTI, 0% of PLTI, and 0% of PI procedures. Bleeding requiring surgical intervention was reported in 0.04% of LTI procedures and not reported for PLTI or PI. Breakage and migration were not reported for any device. Radiographic imaging evaluation reporting implant placement accuracy and fusion was only available for LTI.
Literature support for SI joint fusion is growing. The LTI procedure contains the largest body of available evidence and shows the largest improvements in pain and ODI. Only LTI procedures have independent radiographic evidence of fusion and implant placement. The adverse event rate for all procedures was low.
骶髂关节融合术越来越多地用于治疗慢性骶髂关节疼痛。目前有多种手术方法可供选择。
对已发表的患者队列的安全性和有效性结果进行数据提取和随机效应荟萃分析。患者报告的结局（PROs）和安全指标按手术技术分层：经髂骨，包括外侧经髂骨（LTI）和后外侧经髂骨（PLTI），以及后路置入（PI）手术。
确定了57个队列的2851例患者，包括43个LTI队列（2126例患者）、6个PLTI队列（228例患者）和8个PI手术队列（497例患者）。仅LTI有随机试验。57个队列（2851例患者）有疼痛（数字评分量表）的PROs，37个队列（1978例患者）有残疾（Oswestry残疾指数[ODI]）的PROs。所有有PROs的研究均显示术后较基线有改善。LTI的疼痛评分荟萃分析改善最大（4.8分[0 - 10分制]），PLTI略低（4.2分），PI手术最低（3.8分，P = 0.1533）。LTI的ODI评分平均改善最大（25.9分），PLTI手术最低（6.8分），PI为中等（16.3分，P = 0.0095）。对于安全结局，LTI的急性症状性植入物位置不当为0.43%，PLTI为0%，PI手术为0.2%。LTI的伤口感染报告为0.15%，PLTI为0%，PI为0%。LTI手术中有0.04%报告了需要手术干预的出血，PLTI或PI未报告。任何器械均未报告断裂和移位。仅LTI有关于植入物放置准确性和融合的影像学评估报告。
骶髂关节融合术的文献支持在增加。LTI手术有最多的现有证据，且在疼痛和ODI方面改善最大。只有LTI手术有融合和植入物放置的独立影像学证据。所有手术的不良事件发生率都很低。
