腰椎融合术后骶髂关节源性下腰痛的诊断和治疗

目的探讨腰椎融合术后骶髂关节病变的特点、治疗方法与疗效。方法回顾性分析34例因腰椎管狭窄、腰椎间盘突出、腰椎滑脱曾行后路减压、后外侧或椎体间植骨融合及椎弓根内固定术，术后随访12～48个月（平均30．6个月）出现新的难治性持续性下腰痛症状的病例。运用骶髂关节内封闭进行诊断性治疗。阳性标准：疼痛缓解75％（采用视觉模拟评分法进行定量分析）。结果阳性率为26．5％，术后腰痛部位不同于术前以及融合范围包含L5、S1是具有统计学意义（P〈0．05）。结论腰椎融合术后下腰痛可能部分是由骶髂关节病变引起的，骶髂关节内封闭是当前诊断和治疗骶髂关节源性下腰痛的最有效的方法。

Diagnosis and treatment of Sacroiliac joint pain after lumbar fusion

Objective To discuss the clinical characteristics of sacroiliac joint pain after lumbar fusion as well as its surgical procedure and clinical outcome.Methods A total of 34 cases with prior operation for lumbar canal stenosis or lumbar disc herniation or lumbar degenerative spodylolisthesis were reviewed retrospectively.The prior surgical procedures performed were laminectomy,posterolateral fusion or posterior lumbar interbody fusion and pedicle screw fixation.After an avarage of 30.6 months(12-48 months)following the prior surgery,all cases had a recurrence of low back pain.We used sacroiliac anesthetic blocks to determine this frequency.The diagnostic criterion was a relief of more than 75% of the pain on a visual analog scale.Results We found a 26.5% rate of positive blocks.The pain different from the preoperative pain in its distribution and the fusion including L5,S1 had significant value(P=0.017 and P=0.033,respectively).Conclusion Sacroiliac joint pain after lumbar fusion is one of the causes for recurrence of low back pain which should be distinguished with other causes.For those with marked pain,sacroiliac anesthetic blocks will guarantee good clinical outcome.