ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
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ORIJINAL ARAŞTIRMA

Sakroiliyak Eklem Enjeksiyonunda Floroskopi ile Doğrulanmış Ultrason ve Floroskopi Rehberliğiyle Etkinliğin Karşılaştırılması: Prospektif, Randomize, Kontrollü Çalışma
Comparison of the Efficacy of Sacroiliac Joint Injection Using Fluoroscopy-Confirmed Ultrasound Guidance Versus Fluoroscopy Guidance: A Prospective, Randomized, Controlled Study
Received Date : 04 Dec 2022
Accepted Date : 11 Feb 2023
Available Online : 15 Feb 2023
Doi: 10.31609/jpmrs.2022-94535 - Makale Dili: EN
J PMR Sci. 2023;26(2):214-22
ÖZET
Amaç: Bu çalışmanın amacı, inflamatuar olmayan sakroiliyak eklem (SIE) ağrısı olan hastalarda ultrason (US) ve floroskopi (FL) kılavuzluğunda SIE enjeksiyonlarının doğruluk ve etkinliğini karşılaştırmaktır. Gereç ve Yöntemler: Bu prospektif randomize kontrollü çalışmada, SIE artritine sekonder bel ağrısı olan 60 hasta randomize olarak 2 gruba ayrıldı. Hastalara US veya FL rehberliğinde eklem içi SIE enjeksiyonu yapıldı. Birincil sonuçlar, müdahaleden 12 hafta sonra vizüel analog skala (VAS) skorlarını içeriyordu. İkincil sonuçlar; 1. hafta ve 1. ayda VAS skorları, 1 ve 3. ayda Oswestry Özürlülük İndeksi skorları, 3. ayda Kantitatif Analjezik Anketi ve hasta memnuniyeti, işlem süresi, ilk denemede iğne yerleştirme doğruluğu ve deneme sayısıydı. Bulgular: Her iki teknik de herhangi bir takip noktasında gruplar arasında istatistiksel anlamlılık olmaksızın, başlangıca kıyasla işlem sonrası 3 aya kadar anlamlı ağrı azalması ve fonksiyonel iyileşme sağladı (p<0.01). Gruplar arasında analjezik ilaç tüketimi (p=0,392) ve hasta memnuniyet skorları (p=0,469) açısından anlamlı fark yoktu. SIE tekniğinde ilk denemede, iğne yerleşimi için gruplar arasında anlamlı bir fark olmaksızın, FL (%93,3), US’den (%80) daha yüksek doğruluk gösterdi (p=0,254). Sonuç: Terapötik SIE enjeksiyonları için floroskopik doğrulama ile US kılavuzluğunda SIE enjeksiyonu, FL rehberliğine uygun bir alternatiftir. Her iki gruptaki hastalar ağrı yoğunluğu, işlevsellik ve hasta memnuniyeti açısından benzer fayda gördüler. Bununla birlikte, US rehberliğinde tek başına SIE enjeksiyonunun tanısal performansı, daha düşük doğruluk oranı (%80) nedeniyle sınırlı olabilir.
ABSTRACT
Objective: The aim of this study is to compare the accuracy and effectiveness of ultrasound-(US) and fluoroscopy (FL)-guided sacroiliac joint (SIJ) injections in patients with non-inflammatory SIJ pain. Material and Methods: In this prospective randomized controlled study, 60 patients with non-inflammatory SIJ related pain were randomized into 2 groups. Patients received intra articular SIJ injection under US or FL guidance. Primary outcomes included visual analogue scale (VAS) scores at 12 weeks after intervention. Secondary outcomes were VAS scores at 1 week and 1 month, Oswestry Disability Index scores at months 1 and 3, Quantitative Analgesic Questionnaire and patient satisfaction at 3 months, procedure time, accuracy of needle replacement at the first attempt and number of attempts. Results: Both techniques provided significant pain reduction and functional improvement up to 3 months post-intervention compared with baseline (p<0.001), with no statistical significances between groups at any follow up point. There was no significant difference in pain medication consumption (p=0.392) and patient satisfaction scores (p=0.469) between the groups. The FL guidance for SIJ technique exhibited greater accuracy for needle replacement (93.3%) than the US (80%) at the first attempt, with no significant difference (p=0.254). Conclusion: US-guided SIJ injection with fluoroscopic confirmation is a feasible alternative to FL guidance for therapeutic SIJ injections. Patients in both groups experienced similar treatment benefits regarding pain intensity, functionality and patient satisfaction. However, the diagnostic performance of SIJ injection alone with US guidance may be limited due to the lower accuracy rate (80%).
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