MacLennan A H, MacLennan S C
Department of Obstetrics and Gynecology, Women's of Children's Hospital, the University of Adelaide, North Adelaide, Australia.
Acta Obstet Gynecol Scand. 1997 Sep;76(8):760-4. doi: 10.3109/00016349709024343.
To describe the clinical characteristics and outcomes of a large group of women with symptom-giving pelvic girdle relaxation of pregnancy and postnatal pelvic joint syndrome. To determine if there is an increased incidence of developmental dysplasia of the hip in the children of women with such pelvic problems.
A postal survey of 1,609 Norwegian women registered as having pregnancy-initiated pelvic joint pain. The response rate was 79% and from the answers 1,115 women were defined as having had symptom-giving pelvic joint syndrome of pregnancy and/or postnatal pelvic joint syndrome.
Pelvic pains began in the first pregnancy in 74% of the respondents usually beginning in the first trimester. Pelvic pain worsened with subsequent pregnancies and persisted for a mean of 6.25 years, often causing major incapacity and lifestyle changes. Rest and physical supports brought temporary relief only. Sacroiliac joints and the symphysis pubis were the commonest sites of pain but peripheral joints were also often affected. There was a strong family history of both pelvic joint syndrome and developmental dysplasia of the hip. The incidence of hip dysplasia in the children of women surveyed was 45/1,000 which is 5 times the Norwegian incidence.
Pelvic joint syndrome nearly always follows pelvic girdle relaxation of pregnancy and may have prolonged debilitating effects which do not respond long term to current therapies. The incidence of developmental dysplasia of the hip in the children of these women was high. A genetic susceptibility to joint dysfunction in both mother and fetus, possibly due to an aberration of relaxin physiology, is surmized. Identification of possible relaxin receptor changes in affected joints is a hypothesis worthy of testing with a view to the design of selective relaxin receptor modulators in pregnancy.
描述一大群患有妊娠所致骨盆带松弛和产后骨盆关节综合征的女性的临床特征及结局。确定患有此类骨盆问题的女性的子女中髋关节发育不良的发病率是否增加。
对1609名登记有妊娠引发骨盆关节疼痛的挪威女性进行邮寄调查。回复率为79%，根据回复，1115名女性被定义为患有妊娠所致骨盆关节综合征和/或产后骨盆关节综合征。
74%的受访者骨盆疼痛始于首次妊娠，通常始于孕早期。骨盆疼痛在后续妊娠中加重，平均持续6.25年，常导致严重功能丧失和生活方式改变。休息和使用身体支撑物仅能带来暂时缓解。骶髂关节和耻骨联合是最常见的疼痛部位，但外周关节也常受影响。骨盆关节综合征和髋关节发育不良均有很强的家族病史。被调查女性子女中髋关节发育不良的发病率为45/1000，是挪威发病率的5倍。
骨盆关节综合征几乎总是继发于妊娠所致骨盆带松弛，可能具有长期使人衰弱的影响，目前的治疗方法对此并无长期疗效。这些女性子女中髋关节发育不良的发病率很高。推测母亲和胎儿对关节功能障碍存在遗传易感性，可能是由于松弛素生理异常所致。确定受影响关节中可能存在的松弛素受体变化是一个值得检验的假设，以期设计出妊娠期选择性松弛素受体调节剂。
