介入性疼痛治疗：聚焦安全性与并发症的叙述性综述。第4部分——周围神经、关节、肌肉骨骼及再生干预。

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中文摘要

本系列前三部分分别探讨了脊柱疼痛注射（第1部分）、背痛介入操作（第2部分）以及交感神经和神经节靶向技术（第3部分）的安全性与并发症。这第四篇也是最后一篇文章讨论的是在神经轴和交感链以外进行的干预，这些干预共同构成了日常疼痛诊疗的大部分内容：周围神经和颅神经操作（阻滞、化学性神经毁损、射频、冷冻神经毁损以及周围神经或枕神经刺激）；关节、滑囊和肌腱注射；再生或生物制剂注射；肉毒毒素化学去神经支配；骶髂关节和肌肉骨骼软组织操作；痛性神经瘤的干预；以及痛性骨转移的经皮消融。每一类操作都伴随特征性且偶尔严重的不良事件谱：周围神经和躯干阻滞可发生局部麻醉药全身毒性、气胸和神经损伤；射频和冷冻神经毁损可发生术后神经炎、热损伤和神经瘤；周围神经和枕神经刺激可发生装置相关事件；关节内皮质类固醇可发生感染性关节炎、软骨毒性以及近期认识到的结构性关节效应；生物制剂存在标准化和监管问题；肉毒毒素可导致局部无力、吞咽困难和毒素扩散；骨转移经皮消融可造成邻近结构的热损伤或冷冻损伤以及病理性骨折；骶髂关节和肌肉骨骼软组织操作后的事件大多为一过性。我们还讨论了一个几乎所有这些操作共有但很少被综述的类别：超声引导本身特有的并发症，主要是受污染的凝胶或换能器引起的感染以及针尖显像的陷阱。由于这些靶点大多表浅且适合超声引导，所报告的安全性总体良好；然而，本综述为叙述性和定性性质，且许多基础证据来自病例报告、小系列和异质性队列，因此较低的并发症报告负担不应等同于精确确立的低发生率。正如整个系列所强调的，适当的患者选择、实时图像引导、无菌技术、剂量和容量限制以及对血栓状态（抗血栓状态）的关注是安全性的反复决定因素。

英文摘要

The first three installments of this series examined the safety and complications of injections for spinal pain (Part 1), interventional procedures for back pain (Part 2), and sympathetic and ganglion-targeted techniques (Part 3). This fourth and concluding article addresses the interventions performed away from the neuraxis and the sympathetic chain, which together account for much of everyday pain practice: peripheral and cranial nerve procedures (blocks, chemical neurolysis, radiofrequency, cryoneurolysis, and peripheral or occipital nerve stimulation); joint, bursal, and tendon injections; regenerative or orthobiologic injections; chemodenervation with botulinum toxin; sacroiliac and musculoskeletal soft-tissue procedures; interventions for painful neuroma; and percutaneous ablation of painful bone metastases. Each family carries a characteristic and occasionally serious spectrum of adverse events: local-anesthetic systemic toxicity, pneumothorax, and nerve injury with peripheral and truncal blocks; post-procedural neuritis, thermal injury, and neuroma with radiofrequency and cryoneurolysis; device-related events with peripheral and occipital stimulation; septic arthritis, chondrotoxicity, and the recently recognized structural joint effects of intra-articular corticosteroids; standardization and regulatory concerns with orthobiologics; local weakness, dysphagia, and toxin spread with botulinum toxin; thermal or cryo injury to adjacent structures and pathological fracture with percutaneous ablation of bone metastases; and largely transient events after sacroiliac joint and musculoskeletal soft-tissue procedures. We also address a category common to almost all of these procedures but seldom reviewed: the complications specific to ultrasound guidance itself, chiefly infection from contaminated gel or transducers and the pitfalls of needle-tip visualization. Because most of these targets are superficial and amenable to ultrasound guidance, the reported safety profile is generally favorable; however, this synthesis is narrative and qualitative, and much of the underlying evidence derives from case reports, small series, and heterogeneous cohorts, so a low reported complication burden should not be equated with a precisely established low incidence. As throughout the series, appropriate patient selection, real-time image guidance, aseptic technique, dose and volume limitation, and attention to antithrombotic status are the recurring determinants of safety.