Prather Heidi, Decker Gregory, Bonnette Michael, Simpson Scott, Hunt Devyani, Sahrmann Shirley, Cheng Abby, Nepple Jeffrey
Division of Physical Medicine and Rehabilitation, Departments of Orthopaedic Surgery and Neurology, Washington University School of Medicine, St. Louis, MO.
Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St. Louis, MO.
PM R. 2019 Aug;11 Suppl 1:S46-S53. doi: 10.1002/pmrj.12180. Epub 2019 Jul 25.
Several sacroiliac joint (SIJ) provocative tests used to assess posterior pelvic pain involve moving and stressing the hip. It is unknown if there is a subgroup of patients with posterior pelvic pain who have underlying hip deformity that could potentially influence performance and interpretation of these tests.
To describe the prevalence of radiographic hip deformity and hip osteoarthritis in a group of adults 40 years old and under who met the clinical diagnostic criteria for treatment of posterior pelvic pain with an image guided intra-articular SIJ injection.
Retrospective cohort study.
Tertiary university orthopedic department PATIENTS (OR PARTICIPANTS): One hundred and forty-eight patients were evaluated (83% (123/148) female; mean age 31.3 ± 6.2 years). All had completed a trial of comprehensive noninvasive treatment for posterior pelvic pain and had a minimum of three positive SIJ provocative tests on physical examination.
Retrospective review identified patients undergoing SIJ injection for pain recommended and performed by seven physiatrists between 2011 and 2017. Hip radiographs were read by a physician with expertise in hip measurements with previously demonstrated excellent intrarater reliability.
Percentage of patients with hip deformity findings.
No patients meeting the inclusion criteria had significant radiographic hip osteoarthritis (Tonnis ≥2 indicating moderate or greater radiographic hip osteoarthritis) and 4/148 (3%) were found to have mild radiographic hip osteoarthritis. Prearthritic hip disorders were identified in 123 (83%, 95% CI: 76, 89%) patients. For those patients with prearthritic hip disorders, measurements consistent with femoroacetabular impingement (FAI) were seen in 61 (41%) patients, acetabular dysplasia in 49 (33%) patients, and acetabular retroversion in 85 (57%) patients. Acetabular retroversion was identified in 43% (crossover sign) and 39% (prominent ischial spine) of patients.
Approximately 57% of adult patients under the age of 40 years with the clinical symptom complex of SIJ pain were found to have radiographic acetabular retroversion. This is a higher percentage than the 5%-15% found in asymptomatic people in the current literature. Further study is needed to assess links between hip structure, hip motion, and links to pelvic pain including peri and intra-articular SIJ pain.
III.
几种用于评估骨盆后部疼痛的骶髂关节（SIJ）激发试验涉及髋关节的移动和受力。尚不清楚是否存在骨盆后部疼痛患者的亚组，其潜在的髋关节畸形可能会影响这些试验的表现和解读。
描述一组40岁及以下符合影像引导下关节内SIJ注射治疗骨盆后部疼痛临床诊断标准的成年人中，影像学髋关节畸形和髋骨关节炎的患病率。
回顾性队列研究。
三级大学骨科
患者（或参与者）：对148名患者进行了评估（83%（123/148）为女性；平均年龄31.3±6.2岁）。所有患者均完成了骨盆后部疼痛的综合非侵入性治疗试验，且体格检查至少有三项阳性SIJ激发试验。
回顾性分析确定了2011年至2017年间由七位物理治疗师推荐并实施SIJ注射治疗疼痛的患者。髋部X光片由一位在髋部测量方面具有专业知识的医生解读，其内部评级可靠性此前已得到证实。
有髋关节畸形表现的患者百分比。
符合纳入标准的患者中，无显著的影像学髋骨关节炎（Tonnis≥2表明中度或更严重的影像学髋骨关节炎），148例中有4例（3%）被发现有轻度影像学髋骨关节炎。123例（83%，95%CI：76，89%）患者被确定存在关节炎前期髋关节疾病。在这些有关节炎前期髋关节疾病的患者中，61例（41%）患者的测量结果与股骨髋臼撞击症（FAI）一致，49例（33%）患者存在髋臼发育不良，85例（57%）患者存在髋臼后倾。43%（交叉征）和39%（坐骨棘突出）的患者被确定存在髋臼后倾。
在有SIJ疼痛临床症状复合体的40岁以下成年患者中，约57%被发现存在影像学髋臼后倾。这一比例高于当前文献中无症状人群中发现的5%-15%。需要进一步研究以评估髋关节结构、髋关节运动以及与骨盆疼痛（包括SIJ周围和关节内疼痛）之间的联系。
III级。
