Kurosawa Daisuke, Murakami Eiichi, Aizawa Toshimi
Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital, Sendai, Japan.
Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital, Sendai, Japan.
Clin Neurol Neurosurg. 2017 Oct;161:104-109. doi: 10.1016/j.clineuro.2017.08.018. Epub 2017 Aug 30.
We investigated the prevalence of groin pain in patients with sacroiliac joint (SIJ) dysfunction, lumbar spinal canal stenosis (LSS), and lumbar disc herniation (LDH) who did not have hip disorders, and evaluated the clinical features that distinguished SIJ dysfunction from LSS and LDH.
We evaluated 127 patients (57 men, 70 women, average age 55 years) with SIJ dysfunction, 146 (98 men, 48 women, average age 71 years) with LSS, and 124 (83 men, 41 women, average age 50 years) with LDH. The following data were retrospectively collected from the patients' medical charts: (1) the prevalence of groin pain for each pathology; (2) corresponding spinal level of LSS and LDH in the patients with groin pain; (3) the pain areas in the buttocks and back; pain increase while in positions such as sitting, lying supine, and side-lying; an SIJ shear test; and four tender points composed of the posterior superior iliac spine (PSIS), long posterior sacroiliac ligament (LPSL), sacrotuberous ligament (STL), and iliac muscle.
Fifty-nine (46.5%) patients with SIJ dysfunction, 10 (6.8%) with LSS, and 10 (8.1%) with LDH reported groin pain. Of the 10 patients with LSS, five presented with cauda equina symptoms, two had stenosis of L2-L3, and three had stenosis below L3-L4. The other five presented with radiculopathy: the corresponding nerve root was L2, L3, and L4 in one patient each, and L5 in two. Of the 10 patients with LDH, eight presented with radiculopathy: the corresponding nerve root was L2 and L4 in three patients each, and L5 in two. Two patients presented with L4-L5 discogenic pain without radiculopathy. In patients with groin pain, pain provoked by the SIJ shear test and the tenderness of the PSIS and LPSL were significant physical signs that differentiated SIJ dysfunction from LSS and LDH. (Fisher's exact test, P<0.05) CONCLUSION: The prevalence of groin pain in patients with SIJ dysfunction was higher than in those with LSS or LDH. When patients who do not have hip disorders complain of groin and lumbogluteal pain, not only lumbar disorders but also SIJ dysfunction should be considered.
我们调查了无髋关节疾病的骶髂关节（SIJ）功能障碍、腰椎管狭窄症（LSS）和腰椎间盘突出症（LDH）患者腹股沟疼痛的患病率，并评估了区分SIJ功能障碍与LSS和LDH的临床特征。
我们评估了127例SIJ功能障碍患者（57例男性，70例女性，平均年龄55岁）、146例LSS患者（98例男性，48例女性，平均年龄71岁）和124例LDH患者（83例男性，41例女性，平均年龄50岁）。从患者病历中回顾性收集以下数据：（1）每种病理情况下腹股沟疼痛的患病率；（2）腹股沟疼痛患者中LSS和LDH对应的脊柱节段；（3）臀部和背部的疼痛区域；坐、仰卧和侧卧等体位时疼痛加剧情况；SIJ剪切试验；以及由髂后上棘（PSIS）、骶髂后长韧带（LPSL）、骶结节韧带（STL）和髂肌组成的四个压痛点。
59例（46.5%）SIJ功能障碍患者、10例（6.8%）LSS患者和10例（8.1%）LDH患者报告有腹股沟疼痛。在10例LSS患者中，5例出现马尾神经症状，2例为L2-L3狭窄，3例为L3-L4以下狭窄。另外5例出现神经根病：1例患者对应的神经根分别为L2、L3和L4，2例为L5。在10例LDH患者中，8例出现神经根病：3例患者对应的神经根分别为L2和L4，2例为L5。2例患者出现L4-L5椎间盘源性疼痛但无神经根病。在腹股沟疼痛患者中，SIJ剪切试验诱发的疼痛以及PSIS和LPSL的压痛是区分SIJ功能障碍与LSS和LDH的重要体征。（Fisher精确检验，P<0.05）结论：SIJ功能障碍患者腹股沟疼痛的患病率高于LSS或LDH患者。当无髋关节疾病的患者主诉腹股沟和腰骶部疼痛时，不仅应考虑腰椎疾病，还应考虑SIJ功能障碍。
