Sasaki Takeshi, Kurosawa Daisuke, Murakami Eiichi
Japan Sacroiliac Joint and Low Back Pain Center, Japan Community Healthcare Organization Sendai Hospital, Sendai, Japan.
Department of Orthopedic Surgery, Japan Community Healthcare Organization Sendai Hospital, Sendai, Japan.
Spine Surg Relat Res. 2022 Mar 4;6(5):555-562. doi: 10.22603/ssrr.2021-0239. eCollection 2022 Sep 27.
Most sacroiliac joint (SIJ) disorders are conservatively treated; however, patients with severe pain occasionally require SIJ arthrodesis after failure of continuous conservative management for more than 6 months. We investigated the incidences of preoperative tenderness in the sacrotuberous ligament (STL) and postoperative lower-buttock pain originating from the STL to determine the best way to manage these symptoms to achieve good outcomes.
We retrospectively investigated 33 patients (14 men and 19 women) with a mean age of 47.7 years (range: 25-79 years) who underwent SIJ arthrodesis for severe pain confirmed using diagnostic SIJ injections between April 2009 and December 2019. We investigated the pain improvement at or around the posterior superior iliac spine (PSIS) pre- and postoperatively using the visual analogue scale (VAS) values, incidence of tenderness of the STL before surgery, rate of the persisting STL tenderness, incidence of new-onset STL pain, and treatment options for STL pain postoperatively.
The mean VAS value at or around the PSIS was significantly relieved postoperatively from 85.6 to 31.5 mm (<0.001). Preoperative tenderness of the STL was identified in 21 of 33 patients (63.6%). The STL tenderness resolved after surgery in 12 of these 21 patients (57.1%); however, it persisted in nine patients (42.9%), all of whom were women. Of the 12 patients who did not have preoperative STL tenderness, 4 (33.3%) developed lower-buttock pain and had STL tenderness. In total, 9 (27.3%) of the 33 patients whose progress could be followed up after SIJ arthrodesis had pain originating from the STL; the STL pain in 8 of the 9 patients was relieved after the STL injections and physical therapy.
The STL pain can occur pre- and postoperatively, and management of both persisting and new-onset STL pain after SIJ arthrodesis should be considered to achieve better outcomes.
大多数骶髂关节（SIJ）疾病采用保守治疗；然而，对于疼痛严重的患者，在持续保守治疗超过6个月失败后，偶尔需要进行骶髂关节融合术。我们调查了骶结节韧带（STL）术前压痛的发生率以及术后源自STL的下臀部疼痛情况，以确定处理这些症状以获得良好疗效的最佳方法。
我们回顾性研究了2009年4月至2019年12月期间因诊断性骶髂关节注射证实疼痛严重而接受骶髂关节融合术的33例患者（14例男性和19例女性），平均年龄47.7岁（范围：25 - 79岁）。我们使用视觉模拟量表（VAS）值调查了术前和术后髂后上棘（PSIS）处或其周围的疼痛改善情况、术前STL压痛的发生率、持续存在的STL压痛率、新发STL疼痛的发生率以及术后STL疼痛的治疗选择。
术后PSIS处或其周围的平均VAS值从85.6显著缓解至31.5 mm（<0.001）。33例患者中有21例（63.6%）术前存在STL压痛。这21例患者中有12例（57.1%）术后STL压痛消失；然而，9例（42.9%）持续存在，这些患者均为女性。在12例术前无STL压痛的患者中，4例（33.3%）出现下臀部疼痛并伴有STL压痛。在33例骶髂关节融合术后可随访病情进展的患者中，共有9例（27.3%）有源自STL的疼痛；9例患者中有8例在进行STL注射和物理治疗后STL疼痛得到缓解。
STL疼痛可在术前和术后出现，为获得更好的疗效，应考虑对骶髂关节融合术后持续存在和新发的STL疼痛进行处理。
