采用后路入路同种异体骨微创骶髂关节融合术的临床疗效

Clinical outcomes for minimally invasive sacroiliac joint fusion with allograft using a posterior approach.

作者信息

Moghim Robert, Bovinet Chris, Jin Max Y, Edwards Katie, Abd-Elsayed Alaa

机构信息

Colorado Pain Care, Denver, Colorado, USA.

The Spine Center of Southeast Georgia, Brunswick, Georgia, USA.

出版信息

Pain Pract. 2025 Jan;25(1):e13406. doi: 10.1111/papr.13406. Epub 2024 Aug 23.

DOI:10.1111/papr.13406

PMID:39175334

Abstract

BACKGROUND

Sacroiliac joint (SIJ) dysfunction can occur as a result of injury, degeneration, or inflammation. This dysfunction presents symptoms of pain at various locations, including the low back, hips, buttocks, and legs. The diagnosis of SIJ dysfunction is challenging and cannot be achieved solely with imaging studies such as X-rays, MRI, or CT. The current gold standard diagnostic modality is intra-articular SIJ blocks using two differing local anesthetics. Current treatments for SIJ dysfunction may be beneficial for short-term relief but lack long-term efficacy. The purpose of our study was to examine the outcomes of patients who underwent minimally invasive, posterior SIJ fusion using allograft at a single center.

METHODS

This was a retrospective study which received exemption from the WCG IRB. Data regarding preoperative and postoperative pain levels, surgical time, complications, and medication usage were obtained retrospectively from patient electronic medical records and prescription drug monitoring program reports. No mapping was completed prior to the procedure. Pain was assessed with the 11-point (0-10) Visual Analogue Scale (VAS) and medication usage was assessed using Morphine Milligram Equivalents (MME). Patients were included if they had been diagnosed with SIJ dysfunction using two intra-articular diagnostic blocks that resulted in at least an 80% decrease in pain and had failed conservative management. Patients with sacral insufficiency fractures were excluded.

RESULTS

VAS scores reduced from 8.26 (SD = 1.09) at baseline to 2.59 (SD = 2.57), 2.55 (SD = 2.56), 2.71 (SD = 2.88), and 2.71 (SD = 2.88) at 3, 6, 9, and 12 months, respectively. MME reduced from 78.21 mg (SD = 51.33) to 58.95 mg (SD = 48.64), 57.61 mg (SD = 47.92), 61.71 mg (SD = 45.64), and 66.29 mg (SD = 51.65) at 3, 6, 9, and 12 months, respectively. All reductions in VAS scores and MME were statistically significant. No adverse events occurred, and the average operating room time was 40.16 min (SD = 6.27).

CONCLUSION

Minimally invasive, posterior SIJ fusion using allograft is a safe and efficacious method for managing SIJ dysfunction.

摘要

背景

骶髂关节（SIJ）功能障碍可由损伤、退变或炎症引起。这种功能障碍在包括下背部、臀部、臀部和腿部等不同部位出现疼痛症状。骶髂关节功能障碍的诊断具有挑战性，仅通过X射线、MRI或CT等影像学检查无法确诊。目前的金标准诊断方法是使用两种不同的局部麻醉剂进行关节内骶髂关节阻滞。目前针对骶髂关节功能障碍的治疗可能对短期缓解有益，但缺乏长期疗效。我们研究的目的是在单一中心检查接受同种异体移植的微创后路骶髂关节融合术患者的治疗结果。

方法

这是一项回顾性研究，获得了WCG机构审查委员会的豁免。术前和术后疼痛水平、手术时间、并发症和药物使用情况的数据是从患者电子病历和处方药监测计划报告中回顾性获取的。手术前未完成神经定位。使用11分制（0 - 10）视觉模拟量表（VAS）评估疼痛，并使用吗啡毫克当量（MME）评估药物使用情况。如果患者使用两次关节内诊断性阻滞被诊断为骶髂关节功能障碍，且疼痛至少减轻80%，并且保守治疗失败，则纳入研究。排除骶骨不全骨折患者。

结果

VAS评分从基线时的8.26（标准差 = 1.09）分别降至3个月时的2.59（标准差 = 2.57）、6个月时的2.55（标准差 = 2.56）、9个月时的2.71（标准差 = 2.88）和12个月时的2.71（标准差 = 2.88）。MME分别从78.21毫克（标准差 = 51.33）降至3个月时的58.95毫克（标准差 = 48.64）、6个月时的57.61毫克（标准差 = 47.92）、9个月时的61.71毫克（标准差 = 45.64）和12个月时的66.29毫克（标准差 = 51.65）。VAS评分和MME的所有降低均具有统计学意义。未发生不良事件，平均手术室时间为40.16分钟（标准差 = 6.27）。