Stoev Ivan, Powers Alexander K, Puglisi Joan A, Munro Rebecca, Leonard Jeffrey R
Department of Neurological Surgery, Washington University in St. Louis, St. Louis, MO, USA.
J Neurosurg Pediatr. 2012 Jun;9(6):602-7. doi: 10.3171/2012.2.PEDS11220.
The sacroiliac (SI) joint can be a pain generator in 13%-27% of cases of back pain in adults. These numbers are largely unknown for the pediatric population. In children and especially girls, development of the pelvic girdle makes the SI joint prone to misalignment. Young athletes sustain repeated stress on their SI joints, and sometimes even minor trauma can result in lasting pain that mimics radiculopathy. The authors present a series of 48 pediatric patients who were evaluated for low-back pain and were found to have SI joint misalignment as the cause of their symptoms. They were treated with a simple maneuver described in this paper that realigned their SI joint and provided significant improvement of symptoms.
A retrospective review of the electronic records identified 48 patients who were referred with primary complaints of low-back pain and were determined to have SI joint misalignment during bedside examination maneuvers described here. Three patients did not have a record of their response to treatment and were excluded. Patients were evaluated by a physical therapist and had the realignment procedure performed on the day of initial consultation. The authors collected data regarding the immediate effect of the procedure, as well as the duration of pain relief at follow-up visits.
Eighty percent of patients experienced dramatic improvement in symptoms that had a lasting effect after the initial treatment. The majority of them were given a home exercise program, and only 2 of the 36 patients who experienced significant relief had to be treated again. Fifty-three percent of all patients had immediate and complete resolution of symptoms. Three of the 48 patients had missing data from the medical records and were excluded from computations.
Back pain is multifactorial, and the authors' data demonstrate the potential importance of SI joint pathology. Although the technique described here for treatment of misaligned SI joints in the pediatric patients is not effective in all, the authors have observed significant improvement in 80% of cases. Often it is difficult to determine the exact cause of back pain, but when the SI joint is suspected as the primary pathology, the authors have described a simple and effective bedside treatment that should be attempted prior to the initiation of further testing and surgery.
在成人背痛病例中，骶髂（SI）关节可能是13%-27%的疼痛根源。而在儿科人群中，这些数据大多未知。在儿童尤其是女孩中，骨盆带的发育使骶髂关节易于错位。年轻运动员的骶髂关节承受反复应力，有时即使是轻微创伤也可能导致类似神经根病的持续疼痛。作者报告了一系列48例因下背痛接受评估的儿科患者，发现他们的症状是由骶髂关节错位引起的。他们接受了本文所述的一种简单手法治疗，该手法使骶髂关节复位，并显著改善了症状。
对电子病历进行回顾性分析，确定48例以原发性下背痛为主诉前来就诊且在此处描述的床边检查手法中被判定为骶髂关节错位的患者。3例患者没有治疗反应记录，被排除在外。患者由物理治疗师进行评估，并在初次会诊当天进行复位手术。作者收集了有关该手术即时效果以及随访时疼痛缓解持续时间的数据。
80%的患者症状有显著改善，且在初始治疗后有持久效果。他们中的大多数被给予了家庭锻炼计划，在36例症状明显缓解的患者中，只有2例需要再次治疗。所有患者中有53%症状立即完全缓解。48例患者中有3例病历数据缺失，被排除在计算之外。
背痛是多因素的，作者的数据证明了骶髂关节病变的潜在重要性。尽管本文所述治疗儿科患者骶髂关节错位的技术并非对所有患者都有效，但作者观察到80%的病例有显著改善。通常很难确定背痛的确切原因，但当怀疑骶髂关节是主要病变时，作者描述了一种简单有效的床边治疗方法，应在进一步检查和手术之前尝试。
