AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodol...AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.展开更多
背景:目前运动疗法是非药物治疗腰痛的有效方法,运动疗法可通过骨骼和肌肉之间的机械-化学偶联维持腰椎的稳定,但目前尚无关于运动疗法通过机械-化学偶联缓解慢性非特异性下背痛之间研究进展及最佳治疗方案的明确阐述。目的:综述运动疗...背景:目前运动疗法是非药物治疗腰痛的有效方法,运动疗法可通过骨骼和肌肉之间的机械-化学偶联维持腰椎的稳定,但目前尚无关于运动疗法通过机械-化学偶联缓解慢性非特异性下背痛之间研究进展及最佳治疗方案的明确阐述。目的:综述运动疗法时椎旁肌通过机械-化学偶联影响腰椎稳定性进而缓解慢性非特异性下背痛的相关研究进展,以及目前运动疗法治疗慢性非特异性下背痛的最佳方案。方法:在万方数据库、中国知网、维普、Web of Science和PubMed数据库进行文献检索,以“慢性非特异性下背痛,腰椎稳定,椎旁肌,运动疗法”为中文检索词,以“chronic nonspecific low back pain,lumbar stabilization,paravertebral muscle,exercise therapy”为英文检索词,检索各数据库建库至2024年1月发表的相关文献,最终纳入93篇文献进行归纳总结。结果与结论:运动疗法可以通过适当的机械刺激作用于椎旁肌和骨骼并使其产生相应的变化。运动疗法主要通过机械-化学偶联方式来提高椎旁肌的质量,进而维持腰椎稳定,从而更好地缓解慢性非特异性下背痛,是慢性非特异性下背痛的重要干预措施。但是,对于运动疗法通过腰椎稳定来治疗慢性非特异性下背痛的确切有效方案尚无明确报道。个体化运动方案的制定对于慢性非特异性下背痛的治疗和预后尤为重要。同一个体的肌肉质量与骨骼质量是密切相关的,影像学评估椎旁肌的质量和体积对于疾病的发现和干预具有重要意义。展开更多
目的:探讨基于保护动机理论的延续性护理干预对慢性腰背痛(chronic low back pain,CLBP)患者的影响。方法:选取本院2019年8月-2021年12月就诊的CLBP患者216例,按照护理方法不同分为研究组(n=108)和常规组(n=108)。常规组采用常规护理治...目的:探讨基于保护动机理论的延续性护理干预对慢性腰背痛(chronic low back pain,CLBP)患者的影响。方法:选取本院2019年8月-2021年12月就诊的CLBP患者216例,按照护理方法不同分为研究组(n=108)和常规组(n=108)。常规组采用常规护理治疗,研究组在常规组基础上联合基于保护理论的延续性护理干预,比较两组干预前、干预3个月后视觉模拟量表(visual analogue scale,VAS)、腰椎日本骨科协会评估治疗评分(Japanese Orthopaedic Association score,JOA score)、恐惧-回避信念量表(fear-avoidance belief questionnaire,FABQ)、生活质量综合评定问卷-74(generic quality of life inventory 74,GQOL-74)评分及健康促进行为、护理满意度。结果:干预后与常规组比较,研究组VAS、FABQ评分较低,腰椎JOA、GQOL-74评分较高(P<0.05);研究组健康行为中、高水平例数高于常规组,健康行为低水平例数低于常规组(P<0.05);两组护理满意度比较,研究组95.37%高于常规组83.33%(P<0.05)。结论:基于保护动机理论的延续性护理干预可减轻CLBP患者恐惧回避情绪,缓解腰部疼痛感,提升腰椎功能,还可改善其生活质量及护理满意度。展开更多
目的系统分析射频消融技术治疗腰椎小关节(lumbar facet joint,LFJ)和骶髂关节(sacroiliac joint,SIJ)疼痛的疗效。方法通过计算机检索万方、维普、知网、PuMed/MEDLINE、Embase、Cochrane Central Register of Controlled Trials(CCRCT...目的系统分析射频消融技术治疗腰椎小关节(lumbar facet joint,LFJ)和骶髂关节(sacroiliac joint,SIJ)疼痛的疗效。方法通过计算机检索万方、维普、知网、PuMed/MEDLINE、Embase、Cochrane Central Register of Controlled Trials(CCRCT)、Cochrane Database of Systematic Reviews(CDSR)等数据库,检索射频消融治疗SIJ/LFJ的随机对照研究,进行文献质量评价后,采用Revman 5.3软件进行定量合成分析。结果共纳入9篇随机对照文献和560例患者。Meta分析显示,射频消融可提高SIJ/LFJ患者治疗的临床有效率(OR=16.41,95%CI=2.18~123.28,P=0.007)和优良率(OR=11.94,95%CI=5.02~28.36,P<0.001);射频消融可降低SIJ/LFJ患者的治疗后1周时VAS/NRS评分(WMD=-0.50,95%CI=-0.61~-0.39,P<0.001)、治疗后3个月时VAS/NRS评分(WMD=-1.37,95%CI=-1.82~-0.91,P<0.001)、治疗后6个月时VAS/NRS评分(WMD=-2.25,95%CI=-3.75~-0.75,P=0.003)、治疗后1个月时ODI指数(WMD=-14.86,95%CI=-28.73~-0.99,P=0.04)、治疗后3个月时ODI指数(WMD=-6.00,95%CI=-10.74~-6.53,P=0.01);射频消融对治疗后1 d时VAS/NRS评分(WMD=-0.06,95%CI=-0.35~0.23,P=0.67)、治疗后1个月时VAS/NRS评分(WMD=-0.85,95%CI=-1.91~0.21,P=0.12)和不良反应(OR=0.25,95%CI=0.05~1.29,P=0.10)无显著影响。结论射频消融治疗SIJ/LFJ安全有效。展开更多
文摘AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.
文摘背景:目前运动疗法是非药物治疗腰痛的有效方法,运动疗法可通过骨骼和肌肉之间的机械-化学偶联维持腰椎的稳定,但目前尚无关于运动疗法通过机械-化学偶联缓解慢性非特异性下背痛之间研究进展及最佳治疗方案的明确阐述。目的:综述运动疗法时椎旁肌通过机械-化学偶联影响腰椎稳定性进而缓解慢性非特异性下背痛的相关研究进展,以及目前运动疗法治疗慢性非特异性下背痛的最佳方案。方法:在万方数据库、中国知网、维普、Web of Science和PubMed数据库进行文献检索,以“慢性非特异性下背痛,腰椎稳定,椎旁肌,运动疗法”为中文检索词,以“chronic nonspecific low back pain,lumbar stabilization,paravertebral muscle,exercise therapy”为英文检索词,检索各数据库建库至2024年1月发表的相关文献,最终纳入93篇文献进行归纳总结。结果与结论:运动疗法可以通过适当的机械刺激作用于椎旁肌和骨骼并使其产生相应的变化。运动疗法主要通过机械-化学偶联方式来提高椎旁肌的质量,进而维持腰椎稳定,从而更好地缓解慢性非特异性下背痛,是慢性非特异性下背痛的重要干预措施。但是,对于运动疗法通过腰椎稳定来治疗慢性非特异性下背痛的确切有效方案尚无明确报道。个体化运动方案的制定对于慢性非特异性下背痛的治疗和预后尤为重要。同一个体的肌肉质量与骨骼质量是密切相关的,影像学评估椎旁肌的质量和体积对于疾病的发现和干预具有重要意义。
文摘目的:探讨基于保护动机理论的延续性护理干预对慢性腰背痛(chronic low back pain,CLBP)患者的影响。方法:选取本院2019年8月-2021年12月就诊的CLBP患者216例,按照护理方法不同分为研究组(n=108)和常规组(n=108)。常规组采用常规护理治疗,研究组在常规组基础上联合基于保护理论的延续性护理干预,比较两组干预前、干预3个月后视觉模拟量表(visual analogue scale,VAS)、腰椎日本骨科协会评估治疗评分(Japanese Orthopaedic Association score,JOA score)、恐惧-回避信念量表(fear-avoidance belief questionnaire,FABQ)、生活质量综合评定问卷-74(generic quality of life inventory 74,GQOL-74)评分及健康促进行为、护理满意度。结果:干预后与常规组比较,研究组VAS、FABQ评分较低,腰椎JOA、GQOL-74评分较高(P<0.05);研究组健康行为中、高水平例数高于常规组,健康行为低水平例数低于常规组(P<0.05);两组护理满意度比较,研究组95.37%高于常规组83.33%(P<0.05)。结论:基于保护动机理论的延续性护理干预可减轻CLBP患者恐惧回避情绪,缓解腰部疼痛感,提升腰椎功能,还可改善其生活质量及护理满意度。
文摘目的系统分析射频消融技术治疗腰椎小关节(lumbar facet joint,LFJ)和骶髂关节(sacroiliac joint,SIJ)疼痛的疗效。方法通过计算机检索万方、维普、知网、PuMed/MEDLINE、Embase、Cochrane Central Register of Controlled Trials(CCRCT)、Cochrane Database of Systematic Reviews(CDSR)等数据库,检索射频消融治疗SIJ/LFJ的随机对照研究,进行文献质量评价后,采用Revman 5.3软件进行定量合成分析。结果共纳入9篇随机对照文献和560例患者。Meta分析显示,射频消融可提高SIJ/LFJ患者治疗的临床有效率(OR=16.41,95%CI=2.18~123.28,P=0.007)和优良率(OR=11.94,95%CI=5.02~28.36,P<0.001);射频消融可降低SIJ/LFJ患者的治疗后1周时VAS/NRS评分(WMD=-0.50,95%CI=-0.61~-0.39,P<0.001)、治疗后3个月时VAS/NRS评分(WMD=-1.37,95%CI=-1.82~-0.91,P<0.001)、治疗后6个月时VAS/NRS评分(WMD=-2.25,95%CI=-3.75~-0.75,P=0.003)、治疗后1个月时ODI指数(WMD=-14.86,95%CI=-28.73~-0.99,P=0.04)、治疗后3个月时ODI指数(WMD=-6.00,95%CI=-10.74~-6.53,P=0.01);射频消融对治疗后1 d时VAS/NRS评分(WMD=-0.06,95%CI=-0.35~0.23,P=0.67)、治疗后1个月时VAS/NRS评分(WMD=-0.85,95%CI=-1.91~0.21,P=0.12)和不良反应(OR=0.25,95%CI=0.05~1.29,P=0.10)无显著影响。结论射频消融治疗SIJ/LFJ安全有效。
