Slipman C W, Sterenfeld E B, Chou L H, Herzog R, Vresilovic E
Department of Rehabilitation Medicine, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA.
Arch Phys Med Rehabil. 1998 Mar;79(3):288-92. doi: 10.1016/s0003-9993(98)90008-9.
To determine the clinical validity of provocative sacroiliac joint (SIJ) maneuvers in making the diagnosis of sacroiliac joint syndrome (SIJS).
Prospective constructive cohort study using sacroiliac joint block (SIJB) as the diagnostic gold standard.
Tertiary care center.
Consecutive patients describing low back pain including the region of the sacral sulcus. Physical examination revealed a positive response to three provocative SIJ maneuvers, two of which had to be Patrick's test and pain with palpation over the ipsilateral sacral sulcus.
All subjects underwent fluoroscopically guided SIJB.
Response to SIJB was assessed with visual analog scale (VAS) ratings before and after the block. A reduction of the VAS rating by at least 80% was considered a positive response to SIJB.
Fifty consecutive patients met our criteria and underwent SIJB. Thirty patients had positive response to SIJB, making up the positive SIJS group. Twenty patients had less than 80% pain reduction with SIJB and thus comprised the negative SIJS group. The positive predictive value of provocative SIJ maneuvers in determining the presence of SIJS is therefore 60%.
Our results do not support the use of provocative SIJ maneuvers to confirm a diagnosis of SIJS. Rather, these physical examination techniques can, at best, enter SIJS into the differential diagnosis.
确定激发性骶髂关节（SIJ）手法在诊断骶髂关节综合征（SIJS）中的临床有效性。
以前瞻性构建队列研究，将骶髂关节阻滞（SIJB）作为诊断金标准。
三级医疗中心。
连续的描述下腰痛包括骶沟区域的患者。体格检查显示对三种激发性SIJ手法有阳性反应，其中两种必须是帕特里克试验以及同侧骶沟触诊疼痛。
所有受试者均接受荧光镜引导下的SIJB。
通过阻滞前后的视觉模拟量表（VAS）评分评估对SIJB的反应。VAS评分降低至少80%被认为是对SIJB的阳性反应。
50例连续患者符合我们的标准并接受了SIJB。30例患者对SIJB有阳性反应，构成阳性SIJS组。20例患者经SIJB后疼痛减轻不到80%，因此构成阴性SIJS组。因此，激发性SIJ手法在确定SIJS存在方面的阳性预测值为60%。
我们的结果不支持使用激发性SIJ手法来确诊SIJS。相反，这些体格检查技术充其量只能将SIJS纳入鉴别诊断。
