Laslett Mark
Senior Research Fellow Auckland University of Technology, Auckland, New Zealand; Director of Clinical Services and Clinical Expert, PhysioSouth Ltd, Christchurch, New Zealand.
J Man Manip Ther. 2008;16(3):142-52. doi: 10.1179/jmt.2008.16.3.142.
Sacroiliac joint (SIJ) pain refers to the pain arising from the SIJ joint structures. SIJ dysfunction generally refers to aberrant position or movement of SIJ structures that may or may not result in pain. This paper aims to clarify the difference between these clinical concepts and present current available evidence regarding diagnosis and treatment of SIJ disorders. Tests for SIJ dysfunction generally have poor inter-examiner reliability. A reference standard for SIJ dysfunction is not readily available, so validity of the tests for this disorder is unknown. Tests that stress the SIJ in order to provoke familiar pain have acceptable inter-examiner reliability and have clinically useful validity against an acceptable reference standard. It is unknown if provocation tests can reliably identify extra-articular SIJ sources of pain. Three or more positive pain provocation SIJ tests have sensitivity and specificity of 91% and 78%, respectively. Specificity of three or more positive tests increases to 87% in patients whose symptoms cannot be made to move towards the spinal midline, i.e., centralize. In chronic back pain populations, patients who have three or more positive provocation SIJ tests and whose symptoms cannot be made to centralize have a probability of having SIJ pain of 77%, and in pregnant populations with back pain, a probability of 89%. This combination of test findings could be used in research to evaluate the efficacy of specific treatments for SIJ pain. Treatments most likely to be effective are specific lumbopelvic stabilization training and injections of corticosteroid into the intra-articular space.
骶髂关节（SIJ）疼痛是指源自骶髂关节结构的疼痛。骶髂关节功能障碍通常是指骶髂关节结构的异常位置或运动，这可能会也可能不会导致疼痛。本文旨在阐明这些临床概念之间的差异，并介绍目前关于骶髂关节疾病诊断和治疗的现有证据。骶髂关节功能障碍的检查通常检查者间可靠性较差。骶髂关节功能障碍的参考标准不易获得，因此针对该疾病的检查有效性未知。为诱发熟悉的疼痛而对骶髂关节施加压力的检查具有可接受的检查者间可靠性，并且相对于可接受的参考标准具有临床有用的有效性。尚不清楚激发试验能否可靠地识别骶髂关节外源性疼痛来源。三项或更多项阳性的骶髂关节激发试验的敏感性和特异性分别为91%和78%。在症状无法向脊柱中线移动（即集中）的患者中，三项或更多项阳性试验的特异性增至87%。在慢性背痛人群中，三项或更多项阳性激发试验且症状无法集中的患者患骶髂关节疼痛的概率为77%，在背痛孕妇人群中为89%。这种检查结果的组合可用于研究中评估针对骶髂关节疼痛的特定治疗方法的疗效。最可能有效的治疗方法是特定的腰骶部稳定训练以及向关节腔内注射皮质类固醇。
