Ferreira Rita F, Dias André, Dias Ana Lídia, Barbosa Margarida
Anesthesiology, Faculdade de Medicina da Universidade do Porto, Porto, PRT.
Anesthesiology and Perioperative Medicine, Unidade Local de Saúde de São João, Porto, PRT.
Cureus. 2025 Jun 24;17(6):e86643. doi: 10.7759/cureus.86643. eCollection 2025 Jun.
Sacroiliac joint (SIJ) pain is a significant contributor to low back pain and affects patients´ quality of life. This study aims to (1) stratify patients with SIJ pain based on their clinical history and imaging findings, (2) evaluate the efficacy of ultrasound-guided injection techniques for pain management, and (3) identify predictors of pain relief. Materials and methods: A retrospective observational study was conducted at the chronic pain unit (CPU) of a tertiary hospital, with 75 patients diagnosed with SIJ pain who underwent ultrasound-guided injection treatment between February 2021 and August 2024. Patients were stratified into different groups based on their clinical diagnoses and imaging findings. Pain intensity was assessed using the numeric rating scale (NRS) at baseline, 48 hours, one week, and three months postprocedure. A logistic regression model was applied to assess associations between predictive variables in univariate analysis and the likelihood of significant early pain reduction (≥70%). Variables were iteratively removed if p > 0.10, with the final model retaining predictors with p ≤ 0.05. Results: A cohort of 75 patients underwent 127 ultrasound-guided SIJ injections. Pain reduction of ≥50% was observed in 57.3% of patients at 48 hours postprocedure, declining to 34.7% at three months. SIJ pain and normal magnetic resonance imaging (MRI) significantly increased the likelihood of early pain reduction (OR = 5.13, 95% CI: 1.01-26.13, p = 0.049), and the presence of metabolic disorders (defined as the presence of diabetes mellitus and/or obesity) decreased the likelihood of early pain reduction (OR = 0.28, 95% CI: 0.09-0.95, p = 0.040). The median time to reintervention was 21 months. Metabolic disorders (HR = 2.72, p = 0.010) and cardiovascular comorbidities (hypertension, cardiac diseases, cerebrovascular diseases, peripheral arterial disease) (HR = 2.64, p = 0.011) were associated with a higher risk of earlier recurrence of pain, suggesting a role of systemic health in limiting treatment durability. The complication rate was low (2.67%), consisting only of transient sensory disturbances, with no major adverse effects identified.
Ultrasound-guided SIJ injections provided early pain reduction, with a complication rate of 2.67% limited to transient, self-limited sensory changes. Predictive factors, such as the presence of metabolic disorders, offer insights into patient selection and individualized treatment planning. A clinical diagnosis supported by a positive response to diagnostic injection may be sufficient to confirm SIJ-related pain, although further investigation is needed to elucidate the underlying cause.
骶髂关节（SIJ）疼痛是导致腰痛的重要因素，影响患者的生活质量。本研究旨在：（1）根据患者的临床病史和影像学检查结果对骶髂关节疼痛患者进行分层；（2）评估超声引导下注射技术在疼痛管理中的疗效；（3）确定疼痛缓解的预测因素。材料和方法：在一家三级医院的慢性疼痛科（CPU）进行了一项回顾性观察研究，75例被诊断为骶髂关节疼痛的患者于2021年2月至2024年8月期间接受了超声引导下的注射治疗。根据患者的临床诊断和影像学检查结果将其分为不同组。在基线、术后48小时、1周和3个月时使用数字评分量表（NRS）评估疼痛强度。应用逻辑回归模型评估单因素分析中预测变量与早期显著疼痛减轻（≥70%）可能性之间的关联。如果p>0.10，则迭代去除变量，最终模型保留p≤0.05的预测因素。结果：75例患者共接受了127次超声引导下的骶髂关节注射。术后48小时，57.3%的患者疼痛减轻≥50%，3个月时降至34.7%。骶髂关节疼痛且磁共振成像（MRI）正常显著增加了早期疼痛减轻的可能性（OR = 5.13，95%CI：1.01 - 26.13，p = 0.049），而代谢紊乱（定义为患有糖尿病和/或肥胖症）降低了早期疼痛减轻的可能性（OR = 0.28，95%CI：0.09 - 0.95，p = 0.040）。再次干预的中位时间为21个月。代谢紊乱（HR = 2.72，p = 0.010）和心血管合并症（高血压、心脏病、脑血管疾病、外周动脉疾病）（HR = 2.64，p = 0.011）与疼痛早期复发的较高风险相关，表明全身健康状况在限制治疗持久性方面的作用。并发症发生率较低（2.67%），仅包括短暂的感觉障碍，未发现重大不良反应。结论：超声引导下的骶髂关节注射可实现早期疼痛减轻，并发症发生率为2.67%，仅限于短暂的、自限性的感觉变化。代谢紊乱等预测因素有助于患者选择和个性化治疗方案的制定。尽管需要进一步研究以阐明潜在原因，但诊断性注射阳性反应支持的临床诊断可能足以确诊与骶髂关节相关的疼痛。
