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Diagnostic Sacroiliac Joint Injections: Is a Control Block Necessary?

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Surgical Science 2015年第7期6卷 273-281页

作者： Bruce Mitchell Tomas MacPhail david vivian Paul Verrills Adele Barnard Metro Pain Group Melbourne Australia

Background: Sacroiliac joint (SIJ) pain presents as a deep and somatic pain, predominantly affecting the lower back and buttock and referring down the leg, sometimes as far as the foot. Given that the features of SIJ pain are non-specific and that this referred pain is similar to lumbar facet joint and lumbar disc pain, diagnostic local anesthetic injections (diagnostic blocks) into the SIJ are used to identify the source of pain. Despite wide use, little is known about the false positive rate of a single diagnostic sacroiliac (SI) block and the requirement for a control block. Objective: To determine whether a control SI block is necessary and to monitor the false positive rate for a single injection. Study Design: A prospective and observational study was conducted as part of a practice audit, with data collected over 3.5 years at the authors’ private practice. Patients & Methods: Under fluoroscopic guidance, 1408 consecutive patients presenting with prominent deep somatic pain over the SIJ region were sterilely injected with anesthetic into the SIJ and/or the deep interosseous ligament (DIL). Pain was measured on the 11-point Numerical Rating Scale (NRS) prior to injection and incrementally over the following 1- 2 weeks. Fully completed and unequivocal data sets were available for 1060 patients. Decreases in pain scores (of >80%) at >2 hours of post-injection were indicative of SIJ pain and recorded as a positive SIJ block. Results: Of 1060 patients receiving a first SIJ diagnostic block, 680 (64.1%) recorded a positive result. Subsequently, 271 positive patients and 22 who were negative for SIJ pain opted to receive a second control block. SIJ pain diagnosis was confirmed in 237/271 (87.5%) of those with an initial positive response, while 18/22 patients (81%) had their initial negative result confirmed. The false positive rate of a single block is therefore calculated at 12.5%, and on a contingency table analysis, a single anesthetic SIJ injection has diagnosti

关键词： Sacroiliac Joint Pain Diagnostic Injection Control Block Sensitivity

Radiofrequency Neurotomy for Sacroiliac Joint Pain: A Prospective Study

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Surgical Science 2015年第7期6卷 265-272页

作者： Bruce Mitchell Tomas MacPhail david vivian Paul Verrills Adele Barnard Metro Pain Group Melbourne Australia

Background: The sacroiliac joint (SIJ) is an important cause of chronic low back pain, implicated in 15% - 30% of all cases. While radiofrequency neurotomy (RFN) is the interventional treatment of choice for spinal pain originating from the facet joints, fewer studies have investigated its potential for treating SIJ pain, and its long-term efficacy is unknown. Objectives: To obtain a real-world view of RFN treatment outcomes for SIJ pain by conducting an observational study within a community pain practice, among a heterogeneous patient group receiving standard-of-care diagnostic workup and treatment. Study Design: A prospective, observational study, with data collection over five years, was conducted at the authors' private practice. Patients & Methods: A cohort of 215 patients underwent fluoroscopically guided SIJ RFN of the dorsal and lateral branches of S1-S3 and the descending branch of L5. All patients had previously had their diagnosis of SIJ pain confirmed by controlled comparative analgesic blocks of relevant nerves, and recorded pre-procedure pain levels on the 11-point Numerical Rating Scale (NRS). Outcome measures included pain, and a Likert scale to measure alterations to analgesic use, changes to paid employment status and patient satisfaction. Results: We demonstrate an average pain reduction of 2.3 ± 2.1 NRS points following RFN (baseline pain score of 6.9 ± 1.7 to a follow-up average of 4.6 ± 2.7 NRS points;p ≤ 0.01). At a mean follow-up period of 14.9 ± 10.9 months (range 6 - 49 months), an overall 42.2% of patients reduced their analgesic use. Of the patients for whom employment capacity was applicable (82 patients), 21 patients reported an improvement. Overall, 67% of patients were satisfied with their outcome of post-RFN treatment. No complications occurred. Limitations: This observational study had no independent control group and only included a single study site. Conclusions: RFN is a safe and effective treatment for pain confirmed to origina

关键词： RFN Radiofrequency Denervation Radiofrequency Ablation Sacroiliac Joint Pain Patient Outcome Measures

勇闯7分钟俱乐部纽博格林北环体验迈凯伦P1

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汽车与运动 2014年第2期 88-95页

作者： david vivian 朱峥

这是有史以来最强大的英国超级跑车，与有史以来最刁钻赛道相遇的故事。接下来我们要做的。

关键词： McLaren 格林俱乐部环体超级跑车赛道

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安全之舞难以驯服的BMW M4

汽车与运动 2014年第8期 115-119,114页

作者： david vivian 朱峥

目前BMW M4承担着全球范围内摩托GP车手们的安全但在卡塔尔的赛道上它证实了自己的“安全”并不意味着“驯服”……卡塔尔清晨的阳光就已经让气温来到了30℃,尽管汗流浃背,但这丝毫不影响我对面前这辆BMW M4的痴迷。我并不是全球第一个... 详细信息

目前BMW M4承担着全球范围内摩托GP车手们的安全但在卡塔尔的赛道上它证实了自己的“安全”并不意味着“驯服”……卡塔尔清晨的阳光就已经让气温来到了30℃,尽管汗流浃背,但这丝毫不影响我对面前这辆BMW M4的痴迷。我并不是全球第一个驾驶这辆BMW M4的记者,但我将是第二个。我本应该是第三个,但来自德国的同行媒体正在和BMW M公司的老板Friedrich Nitschke在维修通道的阴凉下愉快地聊着天。所以现在我正在为了能在卡塔尔Losail国际赛车场中顺利地完成6圈驾驶,和并不配合的四点式安全带奋力拼搏着,24小时内,Marc Marquez等人将开始2014年度摩托GP的揭幕战。

关键词：维修通道 BMW M4 我将点式油门踏板防倾杆我不知道副驾驶印第安纳兹莫

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梅赛德斯-奔驰S63 AMG Coupe

汽车与运动 2014年第9期 28-33页

作者： david vivian 吕思达

测试地点:意大利·佛罗伦萨梅赛德斯最大号的轿跑车,比从前有更犀利的外观与更多的先进技术其搭载V8双涡轮发动机,最大功率430kW,最大扭矩900Nm0~100km/h加速仅需4.3s梅赛德斯最大的两门车,以前是CL,而现在被直截了当地称为S-class Cou... 详细信息

测试地点:意大利·佛罗伦萨梅赛德斯最大号的轿跑车,比从前有更犀利的外观与更多的先进技术其搭载V8双涡轮发动机,最大功率430kW,最大扭矩900Nm0~100km/h加速仅需4.3s梅赛德斯最大的两门车,以前是CL,而现在被直截了当地称为S-class Coupe,之前从来没有采用过这么简单的分类方式。本质上是减去了一个系列,而这是一辆经过全新打造的超豪华车,它牺牲了大量的后排空间,但其采用了传统意义上更具诱惑力的设计风格,让它争取到了与高级GTS车型竞争的机会和一些来自喜欢阿斯顿·马丁、宾利、法拉利FF的市场份额。梅赛德斯从来不用为舒适。

关键词：梅赛德斯 S63 AMG Coupe 测试地点最大扭矩阿斯顿·马丁涡轮发动机最大功率宾利

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旷世QPIR参考级便携播放器

高保真音响 2016年第9期 70-71页

作者： david vivian

如果Cartier（卡蒂亚）做一个便携式播放器，它看起来可能像这个样子，但是能有这样顶级的声音吗？

关键词：播放器 Cartier 便携式

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西雅特Leon Cupra 280

汽车与运动 2014年第4期 60-63页

作者： david vivian 韩啸

203kW输出功率,0~100km/h加速仅需5.8s,机械式限滑差速器,所有的这些只需要27万元。你还想要高尔夫GTI吗?从市场营销角度来讲,保持怀疑态度并不总是一件坏事。毕竟,Leon Cupra 280在动力方面还是落后于精心设计改变的大众高尔夫GTI,动... 详细信息

203kW输出功率,0~100km/h加速仅需5.8s,机械式限滑差速器,所有的这些只需要27万元。你还想要高尔夫GTI吗?从市场营销角度来讲,保持怀疑态度并不总是一件坏事。毕竟,Leon Cupra 280在动力方面还是落后于精心设计改变的大众高尔夫GTI,动力性可是小钢炮最注重的方面。不过就目前而言,即便有人拿着X光机。

关键词： Leon Cupra 280 限滑差速器营销角度输出功率运动座椅涡轮增压发动机麦弗逊变传

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英菲尼迪的绝杀

汽车与运动 2014年第7期 21-22页

作者： david vivian 韩啸

日产的高性能臂膀英菲尼迪出大招了,Q50 Eau Rouge——配备GT-R发动机的高性能轿车,意图在自己的主场上向德国宣战!相继在底特律、日内瓦和北京车展亮相之后,英菲尼迪Q50 Eau Rouge被认为是量产车型的一道"绿光"。418kW的输出功率、GT-... 详细信息

日产的高性能臂膀英菲尼迪出大招了,Q50 Eau Rouge——配备GT-R发动机的高性能轿车,意图在自己的主场上向德国宣战!相继在底特律、日内瓦和北京车展亮相之后,英菲尼迪Q50 Eau Rouge被认为是量产车型的一道"绿光"。418kW的输出功率、GT-R发动机、四轮驱动,这辆超级轿车誓将为英菲尼迪目前暂有的所有标杆画上一道跨世纪的分割线,来彰显其品牌的高性能(FX Sebastian Vettel这款车只能算是愚弄了大家)。

关键词：英菲尼迪高性能轿车赛事资源量产车四轮驱动输出功率分割线车身长度车身前部德国人

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兰博基尼之子

汽车与运动 2014年第5期 122-123页

作者： david vivian 范围

Huracn是兰博基尼家族目前最新的入门级跑车,其他车型可以追溯到40年前。

关键词：兰博基尼车辆质量生产数量法拉利原型车 Wallace 悬架设计个人愿望设计原型人体工程