nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2020-4-32-36nnp-1408Research ArticleLECTURESЛЕКЦИЯPuncture technologies in the treatment of pain syndrome caused by sacroiliac joint dysfunctionПункционные технологии в лечении болевого синдрома, вызванного дисфункцией крестцово-подвздошного сочлененияБелозерскихК. А.BelozerskikhK. A.

Константин Александрович Белозерских

Клиника нервных болезней им. А.Я. Кожевникова Университетской клинической больницы №3

119021, Москва, ул. Россолимо, 11, стр. 1

Konstantin Aleksandrovich Belozerskikh

A.Ya. Kozhevnikov Clinic of Nervous System Diseases, University Clinical Hospital Three

11, Rossolimo St., Build. 1, Moscow 119021

sofjar777@gmail.comЕгоровО. Е.EgorovO. E.

Клиника нервных болезней им. А.Я. Кожевникова Университетской клинической больницы №3

119021, Москва, ул. Россолимо, 11, стр. 1

A.Ya. Kozhevnikov Clinic of Nervous System Diseases, University Clinical Hospital Three

11, Rossolimo St., Build. 1, Moscow 119021

ЕвзиковГ. Ю.EvzikovG. Yu.

Клиника нервных болезней им. А.Я. Кожевникова Университетской клинической больницы №3

119021, Москва, ул. Россолимо, 11, стр. 1

A.Ya. Kozhevnikov Clinic of Nervous System Diseases, University Clinical Hospital Three

11, Rossolimo St., Build. 1, Moscow 119021

ШадыжеваТ. И.ShadyzhevaT. I.

Клиника нервных болезней им. А.Я. Кожевникова Университетской клинической больницы №3

119021, Москва, ул. Россолимо, 11, стр. 1

A.Ya. Kozhevnikov Clinic of Nervous System Diseases, University Clinical Hospital Three

11, Rossolimo St., Build. 1, Moscow 119021

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of RussiaRussian Federation2020260820201243236Copyright © Belozerskikh K.A., Egorov O.E., Evzikov G.Y., Shadyzheva T.I., 20202020Белозерских К.А., Егоров О.Е., Евзиков Г.Ю., Шадыжева Т.И.Belozerskikh K.A., Egorov O.E., Evzikov G.Y., Shadyzheva T.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/1408

Sacroiliac joint (SIJ) dysfunction is a cause of low back pain in 10–30% of cases. In 1993, the International Association for the Study of Pain (IASP) defined the following set of diagnostic criteria necessary to diagnose SIJ dysfunction: 1) the presence of pain in the areas characteristic of SIJ lesions, with special attention to pain in the Fortin area projection, with possible different types of radiation; 2) positive pain provocation tests for a SIJ lesion; 3) reduced pain after intra-articular anesthetic injection; 4) the lack of a specific nature of the lesion (fracture, inflammation, tumor, etc.). Injection of 0.5–2.5 ml of solution of an anesthetic (bupivacaine, lidocaine) and 20–40 mg of triamcinolone or 5 mg of betamethasone (1 ml) into the SIJ area is used as interventional technologies. More prolonged analgesia involves radiofrequency denervation (RFD) of the SIJ, in which needles with electrodes are placed in the projection of the nerves that innervate the SIJ, and their local thermal destruction is performed. The effectiveness of RFD of SIJ requires further investigation.

Дисфункция крестцово-подвздошного сочленения (КПС) является причиной болевого синдрома в нижней части спины в 10–30% случаев. Международная ассоциация по изучению боли (IASP) в 1993 г. определила следующий набор диагностических критериев, необходимых для установления диагноза дисфункции КПС: 1) наличие боли в зонах, характерных для поражения КПС, с особым вниманием к боли в проекции зоны Фортина, с возможной различной иррадиацией; 2) положительные результаты при выполнении провокационных тестов, выявляющих поражение КПС; 3) уменьшение боли при внутрисуставном введении анестетика; 4) отсутствие специфического характера поражения (перелом, воспаление, опухоль и т. д.). В качестве интервенционных технологий применяется введение в область КПС 0,5–2,5 мл раствора анестетика (бупивакаин, лидокаин) и 20–40 мг триамцинолона или 5 мг бетаметазона (1 мл). Для более продолжительного обезболивания используется радиочастотная денервация (РЧД) КПС, при которой устанавливают иглы с электродами в проекции нервов, иннервирующих КПС, и выполняют их локальную термодеструкцию. Вопросы эффективности РЧД КПС требуют дальнейшего изучения.

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The authors declare that there are no conflicts of interest present.