Murakami Eiichi, Aizawa Toshimi, Noguchi Kyoko, Kanno Haruo, Okuno Hiroshi, Uozumi Hiroaki
Department of Orthopaedic Surgery, Sendai Shakaihoken Hospital, 3-16-1 Tsutsumi-machi, Sendai 981-0912, Japan.
J Orthop Sci. 2008 Nov;13(6):492-7. doi: 10.1007/s00776-008-1280-0. Epub 2008 Dec 17.
The sacroiliac joint (SIJ) can be a source of low back and lower limb pain. The SIJ pain can originate not only from the joint space but also from the ligaments supporting the joint. Its diagnosis has been difficult because the physical and radiological examinations have proved less than satisfactory. Thus, to know the specific sites of SIJ pain, if these exist, could be very useful for making the diagnosis. The purpose of the present study was to identify the main site of SIJ pain according to the patient's pointing with one finger and to confirm the site by a pain-provocation test and periarticular lidocaine injection.
Forty-six of 247 consecutive patients with low back pain at our outpatient clinic, who could indicate with one finger the main site of the pain, which presented at only one site and was reproducible, were the subjects of this study. The main site of pain was anatomically confirmed by fluoroscopy. Then, a periarticular SIJ injection was performed. The patients were blindly assessed and a diagram of the main site of the SIJ pain was made.
There were 19 males and 27 females and the age averaged 50 years. Eight patients showed a positive placebo response and were excluded from this study. Twenty-five of the remaining 38 patients indicated the main site of pain at the posterior-superior iliac spine (PSIS) or within 2 cm of the PSIS, and 18 of these patients showed a positive effect with periarticular SIJ block. The other 13 patients, including 2 patients with a positive response to the periarticular block, did not show the PSIS as the main site of pain.
Our study clearly indicated that when patients point to the PSIS or within 2 cm of it as the main site of low back pain, using one finger, the SIJ should be considered as the origin of their low back pain.
骶髂关节（SIJ）可能是腰背部和下肢疼痛的一个来源。骶髂关节疼痛不仅可源于关节间隙，还可源于支撑该关节的韧带。其诊断一直很困难，因为体格检查和影像学检查的结果都不尽人意。因此，了解骶髂关节疼痛的具体部位（如果存在的话）对于诊断可能非常有用。本研究的目的是根据患者用单手指指出的部位来确定骶髂关节疼痛的主要部位，并通过疼痛激发试验和关节周围利多卡因注射来确认该部位。
在我们门诊连续就诊的247例腰痛患者中，有46例能用单手指指出疼痛的主要部位，且该疼痛仅出现在一个部位且可重复出现，这些患者为本研究的对象。通过荧光透视在解剖学上确认疼痛的主要部位。然后，进行关节周围骶髂关节注射。对患者进行盲法评估，并绘制骶髂关节疼痛主要部位的示意图。
有19名男性和27名女性，平均年龄为50岁。8例患者显示出阳性安慰剂反应，被排除在本研究之外。其余38例患者中有25例指出疼痛的主要部位在髂后上棘（PSIS）或距PSIS 2厘米范围内，其中18例患者在关节周围骶髂关节阻滞时有阳性效果。其他13例患者，包括2例对关节周围阻滞有阳性反应的患者，未将PSIS作为疼痛的主要部位。
我们的研究清楚地表明，当患者用单手指指出PSIS或其2厘米范围内为腰背痛的主要部位时，应考虑骶髂关节是其腰背痛的来源。
