不同治疗手法对不同损伤类型急性腰扭伤的疗效探讨

目的:探讨急性腰扭伤的不同分型及其不同治疗方法的有效性。方法:根据损伤性质的不同,将急性腰扭伤分为腰后关节紊乱型、腰后关节滑膜嵌顿型、肌绞缩型、肌损伤型、骶髂关节错位型、混合型。根据年龄大小、体质强弱及损伤部位的不同分别采用推顶复位法、顺拔法、推髂扳腿法等治疗方法。结果:经1～3次治疗,症状和体征明显减轻,甚至消失,最多不超过5次。1000例中治愈538例,显效321例,好转141例,有效率达85.9%。结论:手法治疗可使脊柱椎骨间隙变宽、矢状位旋转、冠状位倾斜,椎间软组织,如肌肉、韧带、关节囊、神经根等张力改变,腰椎三维改变得到纠正。     

不同治疗手法对不同损伤类型急性腰扭伤的疗效探讨

目的：探讨急性腰扭伤的不同分型及其不同治疗方法的有效性。方法：根据损伤性质的不同，将急性腰扭伤分为腰后关节紊乱型、腰后关节滑膜嵌顿型、肌绞缩型、肌损伤型、骶髂关节错位型、混合型。根据年龄大小、体质强弱及损伤部位的不同分别采用推顶复位法、顺拔法、推髂扳腿法等治疗方法。结果：经1～3次治疗，症状和体征明显减轻，甚至消失，最多不超过5次。1000例中治愈538例，显效321例，好转141例，有效率达85.9％。结论：手法治疗可使脊柱椎骨间隙变宽、矢状位旋转、冠状位倾斜，椎间软组织，如肌肉、韧带、关节囊、神经根等张力改变，腰椎三维改变得到纠正。     

运动类整复手法缓解胸椎小关节紊乱症背痛38例

目的观察运动关节类整复手法在配合推拿疗法缓解胸椎小关节紊乱症背痛中的作用,初步探讨其作用机制。方法对38例胸椎小关节紊乱症患者,先应用作用于软组织类手法,待局部肌肉放松后,再应用肘压肋椎关节复位法、上胸椎后伸扳法、扳肩推胸法等作用于骨关节的运动类手法。结果颈背疼痛明显缓解,颈部转动自如,胸闷胸痛心悸等症状消失,呼吸自如,一侧上肢后外侧放射痛或麻木感消失26例。上述症状及体征基本消失,疲劳后仍有肩背部不适感,颈项转动时有轻微牵扯感10例。上述症状及体征经治疗后无明显改善,仍有颈背疼痛,转动失灵,胸闷心慌、呼吸不畅等症状2例。结论运动关节类手法有利于恢复胸椎小关节正常的应力平衡,可起到良好的缓解疼痛作用。     

运动类整复手法缓解胸椎小关节紊乱症背痛38例

目的 观察运动关节类整复手法在配合推拿疗法缓解胸椎小关节紊乱症背痛中的作用，初步探讨其作用机制。方法 对38例胸椎小关节紊乱症患者，先应用作用于软组织类手法，待局部肌肉放松后，再应用肘压肋椎关节复位法、上胸椎后伸扳法、扳肩推胸法等作用于骨关节的运动类手法。结果 颈背疼痛明显缓解，颈部转动自如，胸闷胸痛心悸等症状消失，呼吸自如，一侧上肢后外侧放射痛或麻木感消失26例。上述症状及体征基本消失，疲劳后仍有肩背部不适感，颈项转动时有轻微牵扯感10例。上述症状及体征经治疗后无明显改善，仍有颈背疼痛，转动失灵，胸闷心慌、呼吸不畅等症状2例。结论 运动关节类手法有利于恢复胸椎小关节正常的应力平衡，可起到良好的缓解疼痛作用。     

手法结合高频电治疗急性腰扭伤100例分析

目的 根据急性腰扭伤的分型及发病机理，探讨治疗急性腰扭伤便捷、有效的治疗方法。方法 急性腰扭伤分为腰后关节紊乱型、腰后关节嵌顿型、肌肉绞缩型、肌肉劳伤型、骶髂关节错位型、混合型。根据年龄大小及体质强弱分别采用推顶复位法、顺拨法、推髂搬腿法和高频电治疗相结合。结果 经l一3次治疗，症状和体征明显减轻，甚至消失，最多不超过5次。l00例中治愈52例，显效39例，好转9例，显效率达91％。其中50例配合高频电治疗。结论 手法加高频是治疗急性腰扭伤便捷、安全、有效的方法。     

针刀及微调手法治疗产后骶髂关节紊乱疗效观察

目的:探讨产后骶髂关节紊乱的有效疗法。方法:将80例患者随机分为2组。治疗组40例,采用针刀及微调手法并用治疗,对照组40例单独用微调手法治疗。微调每周1次,3次为1个疗程并观察疗效。结果:2组愈显率比较,P0.01,治疗组优于对照组。结论:针刀、微调手法并用治疗产后骶髂关节紊乱疗效明显,值得提倡和推广。     

外伤性骶髂关节半脱位的诊断和治疗

我们于1994年9月～1998年12月骨科门诊诊治急性外伤性骶髂关节半脱位72例,现报告如下。1　临床资料本组72例,男30例,女42例,年龄18～50岁,平均281岁。右侧骶髂关节半脱位40例,左侧32例。Ｘ线检验所见　患者取仰卧位,Ｘ线管向头侧倾斜15～25°摄骨盆斜位片,可见患侧耻骨枝向前移位48例;患侧耻骨枝向后移位24例。两种类型的移位范围2～5ｍｍ,平均31ｍｍ。骶髂关节半脱位的复位方法　①斜扳法(搬肩推臀旋脊法):患者侧卧,患侧下肢屈曲在上,健侧下肢伸直在下,术者一手扳肩,一手推患侧骶髂关节外侧,将脊柱极度旋转后突然顿挫发力使骶髂关节复位。…     

骶髂关节错位误诊单纯腰椎间盘突出症原因分析

目的明确骶髂关节错位误诊单纯腰椎间盘突出症的原因 ,确认骶髂关节错位的诊断要点 ,以便选择最佳的治疗方法。方法将 2 9例骶髂关节错位患者的腰骶部、骨盆X线片、CT片、及MRI片的生理弯曲、椎体间隙、关节间隙、耻骨联合、髂翼对比等变化和症状、体征 ,与相对应神经分布区域进行对照。结果 2 9例骶髂关节错位患者中 ,除其特有体征、症状外 ,X线片提示伴有脊柱退行性改变 2 6例、脊柱序列改变 17例 ,CT片、MRI片提示有椎间盘膨出 2 9例。按骶髂关节错位治疗 3— 10次后 ,痊愈 19例、显效 8例、好转 2例。结论骶髂关节错位虽与腰椎间盘突出症有多种相同症状、体征 ,但治疗方法截然不同 ,只需保守治疗。     

HLA-B27阳性的髋关节滑膜炎误诊病例报告

<正>1病例资料男,20岁。因右大腿内侧牵拉痛1个月来诊。患者1个月前出现右大腿内侧牵拉痛,活动时加重,无明显晨僵,无发热、乏力及其他关节疼痛,未治疗。20 d前症状加重,右腿外旋、外展受限,夜间翻身困难,不能正常行走,当地医院摄骶髂关节X线平片提示可疑右侧骶髂关节炎,查组织相容抗原(HLAB27)阳性,为进一步治疗转我院。门诊行骶髂关节CT扫描未见异常,以强直性脊柱炎(ankylosing     

重建钢板结合骶髂关节螺钉治疗复杂骶髂关节骨折脱位

目的：评价重建钢板结合骶髂关节螺钉技术治疗复杂骶髂关节骨折脱位的临床疗效。方法：对11例髂骨翼骨折合并骶髂关节脱位的Tile C型骨盆骨折病例,采用后路重建钢板结合骶髂关节螺钉技术固定骨盆后环,8例同时固定骨盆前环,采用Matta 评分标准和Majeed 功能评分进行疗效评定。结果：8例前后环同时固定者,术后2周骨盆疼痛消失;3例未行前环固定者,骨盆疼痛消失时间需6周以上,1例骶髂螺钉发生松动。根据Matta评分标准评定,优9例,良2例。根据Majeed功能评分评定,优7例,良4例。结论：对于骶髂关节骨折脱位的Tile C型骨盆骨折,联合重建钢板和骶髂关节螺钉可重建骨盆后环的稳定性,同时固定前环可更快恢复。     

Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial

Background

Manual therapy and exercise therapy are two common treatments for low back pain. Although their effects have been discussed in several studies, the superiority of one over the other for patients with sacroiliac joint dysfunction is still unclear.

Diagnostic Tests for Mechanical Dysfunction of the Sacroiliac Joints

Abstract

Despite almost a century of management of mechanical dysfunction of the sacroiliac joints, no testing procedures have been satisfactorily validated for diagnosis. This paper presents tests that proved to be the most reliable for the management of 57 patients referred by their GPs for treatment of back and leg pain. The patients all regained normal pain-free function after manipulation of the sacroiliac joint(s) followed by a program of modified living and progressively increased walking. The tests include a version of Gillet's test (alternate hip and knee flexion in support standing) revised by the author, passive hip rotations in supine with 90 degrees of hip and knee flexion, and palpation of the superior ligament of the symphysis pubis. This paper proposes that when performed as described, these four tests are worth validating for the diagnosis of sacroiliac joint dysfunction.     

Changes in innominate tilt after manipulation of the sacroiliac joint in patients with low back pain. An experimental study

The purposes of this study were to 1) propose a method to detect sacroiliac joint dysfunction (SIJD), 2) test the interrater reliability of the method on a group of patients with low back pain (LBP), and 3) document changes in innominate tilt after manipulation of the sacroiliac joint. Criteria for SIJD were established by the authors. Twenty-six patients with unilateral LBP were examined independently for presence of SIJD by two examiners. Interrater agreement for presence or absence of SIJD was found to be excellent (Cohen's Kappa = .88). Twenty of the patients who met the criteria for SIJD were randomly assigned to an Experimental Group (n = 10) or a Control Group (n = 10). The left and right innominate bones of these 20 patients were measured for tilt before and after the intervention period. The sacroiliac joint of the patients in the Experimental Group was manipulated during the intervention period, whereas the patients in the Control Group received no treatment. Data were analyzed using a mixed three-factor analysis of variance. The data analysis revealed that the manipulation procedure resulted not only in an altered innominate tilt of the same side but also in an equal and opposite tilt of the opposite side (F = 67.07; df = 1.18; p less than .05). The results indicate that SIJD can be identified reliably in patients with LBP and that a manipulative procedure purported to be specific to the sacroiliac joint changes innominate tilt bilaterally and in opposite directions.     

Physical therapeutic options for residual sacrotuberous ligament pain after treatment of sacroiliac joint dysfunction

[Purpose] To evaluate the incidence of pain originating from the sacrotuberous ligament after sacroiliac joint treatment, and to determine effective physical therapeutic options for sacrotuberous ligament pain. [Participants and Methods] Among 303 patients with sacroiliac joint dysfunction, 57 patients (20 males, 37 females) with persistent lower-buttock pain after sacroiliac joint injections were included in the study. The incidence of sacrotuberous ligament pain and the physical findings from the first evaluation were investigated by physical therapists. [Results] Diagnostic sacrotuberous ligament injections identified lower-buttock pain originating from the sacrotuberous ligament in 57.9% of the patients (33 out of 57 patients) after treatment of sacroiliac joint dysfunction. Of these, 11 patients experienced relief after sacrotuberous ligament injection alone; the others required physical therapy. Sacrotuberous ligament relaxation alone was effective in eight patients; biceps femoris relaxation was required in eight patients; and gluteus maximus contraction exercise was required in six patients. [Conclusion] After sacroiliac joint treatment, the incidence of residual sacrotuberous ligament pain in the persisting lower-buttock pain was 57.9%. In addition to sacrotuberous ligament relaxation, biceps femoris relaxation was effective in patients who showed both higher differences in the straight leg raising test and biceps femoris tenderness, while gluteus maximus contraction exercises were effective in patients with gluteus maximus weakness.     

Sell-Irritationspunkt S1

Objectives

The aim of the present study was to evaluate the morphological correlate of the irritation point S1 described by Karl Sell (Sell’s irritation point S1). Furthermore, the reliability of this irritation point in the context of the 3-stage diagnostics was analyzed concerning the diagnosis of sacroiliac dysfunction.

Patients and methods

The hip joint, lumbar spine and sacroiliac joint were tested in 228 patients using the basis investigation described by James Cyriax to find the source of low back pain. Furthermore, Sell’s irritation point S1 was included in the clinical examination. After the clinical tests using a protocol a distinction could be made between the following sources of low back pain: (1) internal disc disruption of the lower lumbar spine, (2) sciatic nerve pain, (3) sacroiliac joint and (4) zygapophyseal joint of L5/S1. Sell’s irritation point S1 was tested before and after treatment.

Results

An internal disc disruption as the source of low back pain was found in 112 (49.1?%) patients. In 12 (8.8?%) patients the sacroiliac joint was the primary source of low back pain. Sciatic pain was diagnosed in 86 (37.7?%) patients and a combination of discogenic pain and zygapophyseal pain L5/S1 was found in 10 (4.4?%) patients. Sell’s irritation point S1 was negative before treatment in 120 (52.6?%) and positive in 108 (47.4?%) patients. After treatment Sell’s irritation point S1 was unchanged in 136 (59.6?%), more painful in 2 (0.9?%) and less painful in 90 (39.5?%) patients. In comparison between patients of the sacroiliac group and non-sacroiliac group a p-value of 0.252 was statistically analyzed. Sell’s irritation point S1 is neither reliable nor valid with respect to clinical examinations to determine the sacroiliac joint as a source of low back pain.     

Patient characteristics in low back pain subgroups based on an existing classification system. A descriptive cohort study in chiropractic practice

Sub-grouping of low back pain (LBP) is believed to improve prediction of prognosis and treatment effects. The objectives of this study were: (1) to examine whether chiropractic patients could be sub-grouped according to an existing pathoanatomically-based classification system, (2) to describe patient characteristics within each subgroup, and (3) to determine the proportion of patients in whom clinicians considered the classification to be unchanged after approximately 10 days. A cohort of 923 LBP patients was included during their first consultation. Patients completed an extensive questionnaire and were examined according to a standardised protocol. Based on the clinical examination, patients were classified into diagnostic subgroups. After approximately 10 days, chiropractors reported whether they considered the subgroup had changed. The most frequent subgroups were reducible and partly reducible disc syndromes followed by facet joint pain, dysfunction and sacroiliac (SI)-joint pain. Classification was inconclusive in 5% of the patients. Differences in pain, activity limitation, and psychological factors were small across subgroups. Within 10 days, 82% were reported to belong to the same subgroup as at the first visit. In conclusion, LBP patients could be classified according to a standardised protocol, and chiropractors considered most patient classifications to be unchanged within 10 days. Differences in patient characteristics between subgroups were very small, and the clinical relevance of the classification system should be investigated by testing its value as a prognostic factor or a treatment effect modifier. It is recommended that this classification system be combined with psychological and social factors if it is to be useful.     

Sacroiliac joint dysfunction: evaluation and management

Sacroiliac joint dysfunction is believed to be a significant source of low back and posterior pelvic pain. METHODS: To assess the clinical presentation, diagnostic testing, and treatment options for sacroiliac joint dysfunction, a systematic literature review was performed using MEDLINE. RESULTS: Presently, there are no widely accepted guidelines in the literature for the diagnosis and treatment of sacroiliac instability. Establishing management guidelines for this disorder has been complicated by the large spectrum of different etiologic factors, the variability of patient history and clinical symptoms, limited availability of objective testing, and incomplete understanding of the biomechanics of the sacroiliac joint. CONCLUSIONS: A reliable examination technique to identify the sacroiliac joint as a source of low back pain seems to be pain relief following a radiologically guided injection of a local anaesthetic into the sacroiliac joint. Most patients respond to non-operative treatment. Patients who do not respond to non-operative treatment should be considered for operative sacroiliac joint stabilization.     

M��decine manuelle-ost��opathie et articulation sacro-iliaque

Lumbosacral pain is a common reason for medical consultation. Some manual therapists relate it to the pain due to sacroiliac joint dysfunction and provide a manipulative treatment. However, the clinical relevance of diagnostic tests is low, and the effectiveness of sacroiliac joint manipulation is unproved.     

CT导引下的骶髂关节造影及其临床意义初探

目的探讨ＣＴ导引下的骶髂关节造影术及其临床意义。方法对５例骶髂关节病变患者和１５例腰腿痛的志愿者进行ＣＴ导引下的骶髂关节造影,造影后行ＣＴ扫描、Ｘ线拍片并填写疼痛图。结果骶髂关节ＣＴ扫描显影良好,Ｘ线片影像欠清晰。２例有骶髂关节病变患者的ＣＴ扫描发现有造影剂外溢及隐窝。本组共１４例感造影后穿刺侧臀部及大腿后上方酸痛,５例骶髂关节病变患者诉造影术引发的疼痛与术前疼痛部位相同。结论ＣＴ导引下的骶髂关节造影术与传统的造影方法相比,即避免了过多接触Ｘ线照射引起的伤害,又提高了工作效率,为临床诊断和开展相关研究提供了有意义的影像学信息。