Ultrasound-Guided Versus Fluoroscopy-Guided Sacroiliac Joint Intra-articular Injections in the Noninflammatory Sacroiliac Joint Dysfunction: A Prospective, Randomized, Single-Blinded Study

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• 作者：Haemi Jee ; PhD^a ; Ji-Hae Lee ; MD^b ; Ki Deok Park ; MD^c ; Jaeki Ahn ; MD ; PhD^d ; Yongbum Park ; MD^d ; ^{swc328@daum.net" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Fluoroscopy ; Injections ; Rehabilitation ; Sacroiliac joint ; Ultrasonography
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2014
• 出版时间：February 2014
• 年：2014
• 卷：95
• 期：2
• 页码：330-337
• 全文大小：1446 K

文摘

To compare the short-term effects and safety of ultrasound (US)-guided sacroiliac joint (SIJ) injections with fluoroscopy (FL)-guided SIJ injections in patients with noninflammatory SIJ dysfunction.

Design

Prospective, randomized controlled trial.

Setting

University hospital.

Participants

Patients (N=120) with noninflammatory sacroiliac arthritis were enrolled.

Intervention

All procedures were performed using an FL or US apparatus. Subjects were randomly assigned to either the FL or US group. Immediately after the SIJ injections, fluoroscopy was applied to verify the correct placement of the injected medication and intravascular injections.

Main Outcome Measures

Treatment effects and functional improvement were compared at 2 and 12 weeks after the procedures.

Results

The verbal numeric pain scale and Oswestry Disability Index improved at 2 and 12 weeks after the injections without statistical significances between groups. Of 55 US-guided injections, 48 (87.3%) were successful and 7 (12.7%) were missed. The FL-guided SIJ approach exhibited a greater accuracy (98.2%) than the US-guided approach. Vascularization around the SIJ was seen in 34 of 55 patients. Among the 34 patients, 7 had vascularization inside the joint, 23 had vascularization around the joint, and 4 had vascularization both inside and around the joint. Three cases of intravascular injections occurred in the FL group.

Conclusions

The US-guided approach may facilitate the identification and avoidance of the critical vessels around or within the SIJ. Function and pain relief significantly improved in both groups without significant differences between groups. The US-guided approach was shown to be as effective as the FL-guided approach in treatment effects. However, diagnostic application in the SIJ may be limited because of the significantly lower accuracy rate (87.3%).