经双侧骶外侧支阻滞筛选的患者中，骶外侧支射频神经切断术治疗骶髂关节后复合体疼痛的有效性：一项真实世界队列研究。
The effectiveness of sacral lateral branch radiofrequency neurotomy for posterior sacroiliac joint complex pain in patients selected by dual sacral lateral branch blocks; A real-world cohort study.
作者信息
Boos Austin, Cooper Amanda, Martin Brook, Burnham Robert, Glinka Przybysz Allison, Conger Aaron M, McCormick Zachary L, Burnham Taylor R
机构信息
Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.
Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
出版信息
Interv Pain Med. 2024 Oct 30;3(4):100442. doi: 10.1016/j.inpm.2024.100442. eCollection 2024 Dec.
BACKGROUND
Previous study of spinal neurotomy procedures indicates that stringent block selection improves outcomes. However, this pattern is not established for sacral lateral branch radiofrequency neurotomy (SLBRFN). Few SLBRFN studies have used stringent block selection criteria such as ≥80 % pain reduction following dual sacral lateral branch blocks (SLBB).
OBJECTIVE
Evaluate the effectiveness of SLBRFN in patients with ≥80 % pain relief following dual SLBBs.
METHODS
Retrospective single-arm cohort study of consecutive patients from two Canadian musculoskeletal and pain clinics who underwent first-time SLBRFN after report of ≥80 % pain relief following dual diagnostic SLBBs. Patients were identified by electronic medical record query between 2016 and 2022. The primary outcome was the proportion of individuals with a ≥50 % reduction in the numeric pain rating scale (NPRS) score three months after SLBRFN. Secondary outcomes included the proportion of responders achieving the minimal clinically important difference (MCID) on the pain disability quality-of-life questionnaire (PDQQ), and the duration and mean percentage of pain relief among those with recurrent symptoms after a successful SLBRFN.
RESULTS
Of the 70 participants included, 32 (45.7 %; 95 % CI = 34.6-57.3) reported a ≥50 % reduction in NPRS, and 35 (50.0 %; 95 % CI = 38.6-61.4) achieved the MCID on the PDQQ at 3-months. Among the 17 patients who reported a return of symptoms, the mean duration of relief was 8.0 ± 3.5 months, and the mean percentage of pain relief was 77.9 % ± 16.4 %. Logistic regression models revealed that the use of multi-tined RF probes and lower patient BMI were associated with treatment success.
DISCUSSION/CONCLUSION: SLBRFN reduced pain and disability in approximately 50 % of patients at 3 months when selected using relatively restrictive selection criteria. Treatment success was associated with multi-tined RF probe type and lower patient BMI. Larger prospective studies assessing long-term outcomes are needed to further evaluate the impact of different selection criteria and techniques on SLBRFN effectiveness.
背景
先前对脊髓神经切断术的研究表明，严格的阻滞选择可改善治疗效果。然而，这种模式在骶外侧支射频神经切断术（SLBRFN）中尚未确立。很少有SLBRFN研究使用严格的阻滞选择标准，如双侧骶外侧支阻滞（SLBB）后疼痛减轻≥80%。
目的
评估SLBRFN对双侧SLBB后疼痛缓解≥80%的患者的有效性。
方法
对来自加拿大两家肌肉骨骼和疼痛诊所的连续患者进行回顾性单臂队列研究，这些患者在报告双侧诊断性SLBB后疼痛缓解≥80%后首次接受SLBRFN。通过2016年至2022年的电子病历查询识别患者。主要结局是SLBRFN术后三个月数字疼痛评分量表（NPRS）评分降低≥50%的个体比例。次要结局包括在疼痛残疾生活质量问卷（PDQQ）上达到最小临床重要差异（MCID）的缓解者比例，以及成功进行SLBRFN后复发症状患者的疼痛缓解持续时间和平均百分比。
结果
在纳入的70名参与者中，32名（45.7%；95%CI=34.6-57.3）报告NPRS降低≥50%，35名（50.0%；95%CI=38.6-61.4）在3个月时在PDQQ上达到MCID。在17名报告症状复发的患者中，缓解的平均持续时间为8.0±3.5个月，疼痛缓解的平均百分比为77.9%±16.4%。逻辑回归模型显示，使用多尖射频探头和较低的患者体重指数与治疗成功相关。
讨论/结论：当使用相对严格的选择标准进行选择时，SLBRFN在3个月时可使约50%的患者疼痛和残疾减轻。治疗成功与多尖射频探头类型和较低的患者体重指数相关。需要进行更大规模的前瞻性研究来评估不同选择标准和技术对SLBRFN有效性的影响。
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