Hronisku sāpju invazīvās ārstēšanas izvērtēšana ar termogrāfiju
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Latvijas Universitāte
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lav
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Ievads – hroniskas sāpes ir izplatīta problēma un vidēji tās skar līdz pat trešdaļu pasaules iedzīvotāju. RF ablācija un LA, un GK injekcija sāpju mazināšanai ir pierādījusi savu efektivitāti. Termogrāfijas izmantošana terapijas efektivitātes noteikšanai dotu objektīvu priekšstatu par patieso terapijas iestāšanās laiku. Hipotēze – ar termogrāfijas metodi var noteikt temperatūras izmaiņas pēc dažādām mazinvazīvām manipulācijām, kas ietver LA un GK injekciju SI locītavā, kā arī RF ablāciju sakrālajiem nerviem. Mērķis –salīdzināt divu mazinvazīvu ārstēšanas metožu – RF ablācijas sakrālajiem nerviem kopā ar LA injekciju un LA, GK injekciju SI locītavā – efekta iestāšanās laiku izmantojot termogrāfijas kameru, kā arī salīdzināt abu metožu efektivitāti. Metodes - Pētījums tika veikts Traumatoloģijas un ortopēdijas slimnīcā, kā arī klīnikā “Ortomed”. Termogrāfijas uzņēmums tika veikts trīs reizes – pirms, pēc un 20 minūtes pēc procedūras, paralēli tam, kā arī mēnesi pēc procedūras tika noskaidrots pacienta sāpju vērtējums pamatojoties uz numeriskās analogās skalas. Rezultāti – 20 minūtes pēc procedūras var vērot, ka RF ablācijas un LA injekcijas grupā visas temperatūras vai nu nemainās, vai paaugstinās: lokālās temperatūras ΔT ir 0,0, reģiona maksimālās temperatūras ΔT ir 1,6, reģiona minimālās temperatūras ΔT ir 1,3, bet reģiona vidējās temperatūras ΔT ir 1,55, savukārt LA + GK injekcijas grupā attiecīgās temperatūras starpības (ΔT ) secīgi ir -0,57, 0,08, -0,47, -0.1. Īstermiņā mazākas sāpes tiek atzīmētas RF ablācijas un LA injekcijas pacientu grupa (vidēji 1,25 balles), taču LA + GK injekcijas grupas pacientiem – 2,43 balles. Ilgtermiņā RA ablācijas + LA injekcijas grupas pacientiem – 4 balles, LA + GK injekcijas pacientiem – 3,4 balles. Secinājumi: 1.Terapijas efekta iestāšanās laiku ir iespējams noteikt izmantojot termogrāfijas kameru, bet būtiskas temperatūras izmaiņas starp abām metodēm netika konstatētas, jo abos gadījumos tika izmantota lokālā anestētiķa injekcija. 2.RF ablācijas un LA injekcijas grupai temperatūras izmaiņas nav statistiski nozīmīgas, bet ir tendence pieaugt reģiona vidējai temperatūrai par 5,49%. LA + GK injekcijas grupas pacientiem ir tendence mazināties lokālajai temp. par 1,84% un vidējai reģiona temperatūrai pieaugt par 6,68%. 3.Izvērtējot sāpes īstermiņā, RF ablācijas + LA injekcijas pacientu grupā sāpes mazinājās par 80,77%, bet LA +GK injekcijas grupā – par 67,9%, taču ilgtermiņa efekts labāks tika novērots LA +GK injekcijas grupā, sāpēm mazinoties par 55,09% bet RF ablācijas + LA injekcijas grupā par 38,5%. 4. Termogrāfija kā metode var tikt izmantota, lai novērtētu terapijas iedarbību uz mērķa struktūru.
Introduction – chronic pain is a common problem and affects up to a third of the world's population on average. RF ablation and LA and GC injection for pain relief have proven their effectiveness. The use of thermography to determine the effectiveness of therapy would provide an objective picture of the true onset time of therapy. Hypothesis – the thermography method can determine temperature changes after various minimally invasive manipulations, which include LA and GC injection into the SI joint, as well as RF ablation of the sacral nerves. Objective – to compare the onset time of two minimally invasive treatment methods – RF ablation of the sacral nerves together with LA injection and LA, GC injection into the SI joint – using a thermography camera, as well as to compare the effectiveness of both methods. Methods - The study was conducted at the Traumatology and Orthopedics Hospital, as well as at the “Ortomed” clinic. Thermography was performed before, after and 20 minutes after the procedure, in parallel with this, as well as a month after the procedure, the patient's pain assessment was determined based on a numerical analog scale. Results - 20 minutes after the procedure, it can be observed that in the RF ablation and LA injection group: local temp. ΔT is 0.0, maximum regional temp. ΔT is 1.6, minimum regional temp. ΔT is 1.3, and average regional temp. ΔT is 1.55, while in the LA + GC inj. group, the corresponding temp. differences (ΔT ) are -0.57, 0.08, -0.47, -0.1. In the short term, less pain is noted in the RF ablation and LA inj. group of patients (1.25 points), but in the LA + GC injection group of patients – 2.43 points. In the long term, in the RA ablation + LA inj. group of patients – 4 points, in the LA + GC inj. patients – 3.4 points. Conclusions: 1. The time of onset of the therapeutic effect can be determined using a thermography camera, but significant temp. changes between the two methods were not detected, because in both cases a local anesthetic injection was used. 2. In the RF ablation and LA injection group there is a tendency for the average regional temp. to increase by 5.49%. In the LA + GC inj. group of patients, there is a tendency for the local temp. to decrease by 1.84% and the average regional temp. to increase by 6.68%. 3. When evaluating pain in the short term, in the RF ablation + LA injection group of patients, pain decreased by 80.77%, and in the LA + GC injection group – by 67.9%, but the long-term effect was better observed in the LA + GC injection group, with pain decreasing by 55.09% and in the RF ablation + LA injection group by 38.5%. 4. Thermography as a method can be used to assess the effect of therapy on the target structure.
Introduction – chronic pain is a common problem and affects up to a third of the world's population on average. RF ablation and LA and GC injection for pain relief have proven their effectiveness. The use of thermography to determine the effectiveness of therapy would provide an objective picture of the true onset time of therapy. Hypothesis – the thermography method can determine temperature changes after various minimally invasive manipulations, which include LA and GC injection into the SI joint, as well as RF ablation of the sacral nerves. Objective – to compare the onset time of two minimally invasive treatment methods – RF ablation of the sacral nerves together with LA injection and LA, GC injection into the SI joint – using a thermography camera, as well as to compare the effectiveness of both methods. Methods - The study was conducted at the Traumatology and Orthopedics Hospital, as well as at the “Ortomed” clinic. Thermography was performed before, after and 20 minutes after the procedure, in parallel with this, as well as a month after the procedure, the patient's pain assessment was determined based on a numerical analog scale. Results - 20 minutes after the procedure, it can be observed that in the RF ablation and LA injection group: local temp. ΔT is 0.0, maximum regional temp. ΔT is 1.6, minimum regional temp. ΔT is 1.3, and average regional temp. ΔT is 1.55, while in the LA + GC inj. group, the corresponding temp. differences (ΔT ) are -0.57, 0.08, -0.47, -0.1. In the short term, less pain is noted in the RF ablation and LA inj. group of patients (1.25 points), but in the LA + GC injection group of patients – 2.43 points. In the long term, in the RA ablation + LA inj. group of patients – 4 points, in the LA + GC inj. patients – 3.4 points. Conclusions: 1. The time of onset of the therapeutic effect can be determined using a thermography camera, but significant temp. changes between the two methods were not detected, because in both cases a local anesthetic injection was used. 2. In the RF ablation and LA injection group there is a tendency for the average regional temp. to increase by 5.49%. In the LA + GC inj. group of patients, there is a tendency for the local temp. to decrease by 1.84% and the average regional temp. to increase by 6.68%. 3. When evaluating pain in the short term, in the RF ablation + LA injection group of patients, pain decreased by 80.77%, and in the LA + GC injection group – by 67.9%, but the long-term effect was better observed in the LA + GC injection group, with pain decreasing by 55.09% and in the RF ablation + LA injection group by 38.5%. 4. Thermography as a method can be used to assess the effect of therapy on the target structure.