英汉对照骨科患者指南027：骶髂关节紊乱（上）

Sacroiliac Joint Dysfunction

骶髂关节紊乱

A Patient’s Guide to Sacroiliac Joint Dysfunction

骶髂关节紊乱患者指南

Introduction

引言

A painful sacroiliac joint is one of the more common causes of mechanical low back pain. Sacroiliac (SI) joint dysfunction is a term that is used to describe the condition – because it is still unclear why this joint becomes painful and leads to low back pain. Sacroiliac joint dysfunction can be a nuisance but it is seldom dangerous and rarely leads to the need for surgery. Most people who suffer from this problem can reduce the pain and manage the problem with simple methods.

       骶髂关节疼痛是机械性腰背痛的常见原因之一。因为骶髂关节发生疼痛和导致腰背痛的原因尚不明确，所以用“骶髂关节紊乱”这个词组来描述这种病症。骶髂关节紊乱是一件恼人的事情，但是很少有危险性，极少需要手术。大多数这个疾病的患者可以用简单的方法来控制疼痛和治疗这个病症。

This guide will help you understand

       这个指南有助于你理解：

· how the problem develops

· how doctors diagnose the condition

· what treatment options are available

       · 这个问题是如何发生的？

       · 医生怎样诊断这个病症？

       · 有什么治疗方法？

Anatomy

解剖

What part of the back is involved?

       病变发生在背部的哪个部位？

At the lower end of the spine, just below the lumbar spine lies the sacrum. The sacrum is a triangular shaped bone that is actually formed by the fusion of several vertebrae during development. The sacroiliac (SI) joint sits between the sacrum and the iliac bone (thus the name “sacroiliac” joint). You can see these joints from the outside as two small dimples on each side of the lower back at the belt line.

       骶骨是一块三角形的骨骼，位于脊柱下端，在腰椎的下面，是由几块椎体在发育过程中融合而成的。骶髂关节位于骶骨和髂骨之间（骶髂关节因此而命名）。你在体表可以看到背部腰带线下两侧的两个小凹陷就是骶髂关节所在的位置。

The SI joint is one of the larger joints in the body. The surface of the joint is wavy and fits together similar to the way Legos? fit together. Very little motion occurs in the SI joint. The motion that does occur is a combination of sliding, tilting and rotation. The most the joint moves in sliding is probably only a couple of millimeters, and may tilt and rotate two or three degrees.

       骶髂关节是人体较大的关节之一。关节面如波浪般起伏不平，却又像乐高积木那样相互嵌合在一起。骶髂关节的活动结合了滑动、倾斜和旋转，但是活动度很小。最大关节滑动幅度可能是几个毫米，倾斜和旋转可以是2到3度。

The SI joint is held together by several large, very strong ligaments. The strongest ligaments are in the back of the joint outside of the pelvis. Because the pelvis is a ring, these ligaments work somewhat like the hoops that hold a barrel together. If these ligaments are torn, the pelvis can become unstable. This sometimes happens when a fracture of the pelvis occurs and the ligaments are damaged. Generally, these ligaments are so strong that they are not completely torn with the usual injury to the SI joint.

       骶髂关节由一些强大的韧带维系在一起。最坚强的韧带在关节后方的盆骨外。骨盆是一个环形，这些韧带的作用就像箍圈把木桶箍拢。如果韧带断裂了，骨盆会变得不稳定。这种情况偶尔会在骨盆骨折和韧带损坏的时候发生。通常在骶髂关节普通的损伤中，这些坚强的韧带不会完全撕裂。

The SI joint hardly moves in adults. During the end of pregnancy as delivery nears, the hormones that are produced causes the joint to relax. This allows the pelvis to be more flexible so that birth can occur more easily. Multiple pregnancies seem to increase the amount of arthritis that forms in the joint later in life. Other than the role the joint plays in pregnancy, it does not appear that motion is important to the function of the joint. The older one gets, the more likely that the joint is completely ankylosed, a term that means the joint has become completely stiffened with no movement at all. It appears that the primary function of the joint is to be a shock absorber and to provide just enough motion and flexibility to lessen the stress on the pelvis and spine.

       成人的骶髂关节几乎不活动。在妊娠后期临近分娩时，产生的激素使得关节松弛。这使骨盆更有弹性，分娩就更容易。多胎妊娠似乎增加了在日后的生活中关节炎的发生率。除了在妊娠中的作用，活动对于骶髂关节来说不是重要的功能。年纪越大，越有可能发生关节完全僵硬，也就是说关节变得完全不能活动。看起来骶髂关节的主要功能是避震器，并为降低骨盆和脊柱的应力提供足够的活动度和柔韧性。

Related Document: A Patient’s Guide to Lumbar Spine Anatomy

相关阅读：腰椎解剖患者指南（翻译招募中，有意者请留言）

精美视频：腰椎解剖（lumbar spine anatomy）

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Causes

病因

What causes this problem? 

       导致本病的原因是什么？

There are many different causes of SI joint pain. Pregnancy may be a factor in the the development of SI joint problems later in life. Also, if a person has one leg is shorter than the other, the abnormal alignment may end up causing SI joint pain and problems. Often, an exact cause leading to a painful SI joint condition can’t be found. The joint simply gets painful, and the patient and provider don’t have an answer as to why the joint has become painful. 

         很多不同的病因可以引起骶髂关节疼痛。妊娠可能是日后发生骶髂关节疾患的一个因素。如果一个人的两条腿不一样长，这种不正常的对线最终也可能引起骶髂关节的疼痛和病症。骶髂关节疼痛性疾病的病因常常不能明确。关节就这样地痛了，病人和医生都搞不明白为什么会痛。

The SI joint is a synovial joint, similar to all joints such as the knee, hip and shoulder. Because of this, different types of arthritis that affect all the joints of the body will also affect the sacroiliac joint. This includes conditions such as rheumatoid arthritis, gout and psoriasis. The joint can be infected when bacteria that travel in the blood settle in the joint causing a condition called septic arthritis. This is perhaps the most worrisome cause of SI joint pain and may well require surgery to drain the infection.

       骶髂关节是滑膜关节，类似于膝、髋和肩关节等所有关节。正因为如此，影响身体所有关节的不同类型的关节炎也会影响骶髂关节。这包括类风湿性关节炎、痛风和银屑病等疾病。当侵入血流的细菌定植到了关节，可以造成关节感染，这被称为化脓性关节炎。这也许是最令人担忧的骶髂关节疼痛的原因，可能需要手术对感染病灶进行引流。

Injury to the SI joint is thought to be a common cause of pain. Injury can occur during an automobile accident. One common pattern of injury occurs when the driver of a vehicle places one foot on the brake before a collision. The impact through the foot on the brake is transmitted to the pelvis causing a twisting motion to this side of the pelvis. This can injure the SI joint on that side resulting in pain. A similar mechanism occurs with a fall on one buttock. The force again causes a twisting motion to the pelvis and may injure the ligaments around the joint.

       骶髂关节损伤被认为是一种常见的疼痛原因。损伤可能会源于一场汽车事故。一个常见的损伤模式是司机在碰撞发生前用一只脚踩着刹车。冲击力从踩刹车的脚传送到骨盆，造成这一侧的骨盆扭转。这会损伤这一侧的骶髂关节，最终引起疼痛。一个类似的机制发生于跌倒时单侧臀部着地。应力同样地会导致骨盆的扭转运动，有可能伤害关节周围韧带。

Symptoms

症状

What does the condition feel like?

       得了这种疾病会有什么感觉？

The most common symptoms from SI joint dysfunction are low back and buttock pain. The pain may affect one side or both SI joints. The pain can radiate down the leg all the way to the foot and may be confused with a herniated disc in the lumbar spine. The pain may radiate into the groin area. People often feel muscle spasm in one or both of their buttocks muscles.

       骶髂关节紊乱最常见的症状是下背部和臀部疼痛。疼痛可能影响到单侧或者双侧关节。疼痛可以沿下肢放射到足部，可能与腰椎间盘突出症相混淆。疼痛可以放射到腹股沟区。人们常常感到他们一侧或两侧的臀部肌肉发生痉挛。

Problems with the SI joint may make sitting difficult. Pain in one SI joint may cause a person to sit with that buttock tilted up. It is usually uncomfortable to sit flat in a chair.

       骶髂关节的疾病可能会让病人难以就座。一侧骶髂关节疼痛可能让病人坐下要用单侧臀部倾斜的姿势。在椅子上坐平常常会不舒服。

Diagnosis

诊断

How do doctors diagnose the problem?

       医生如何诊断这个疾病？

Diagnosis begins with a complete history and physical exam. Your doctor will ask questions about your symptoms and how the pain is affecting your daily activities. Your doctor will also want to know what positions or activities make your symptoms worse or better. You will be asked about any injuries in the past and about any other medical problems you might have such as any arthritis that runs in the family.

       诊断从完整的病史和体格检查开始。医生会询问你的症状，以及疼痛如何影响你的日常活动。医生也会想知道什么体位或活动使你的症状更差，或者更好些。你要回答过去是否受过任何创伤，以及是否有其他任何的医学问题，比如家族遗传的任何关节炎等。

Your doctor then examines you by checking your posture, how you walk and where your pain is located. Your doctor checks to see which back movements cause pain or other symptoms. Your skin sensation, muscle strength, and reflexes are also tested because it is difficult to distinguish pain coming from the SI joint from pain coming from other spine conditions.

       然后，医生检查你的姿势，走路姿势和疼痛部位。医生会检查背部的哪些运动能引起疼痛或其他症状。你的皮肤感觉、肌肉力量和反射也要检查，因为来自骶髂关节的疼痛与来自其他脊柱疾患的疼痛很难区分。

Laboratory tests may be ordered if there is any question whether you might have an infection or some type of arthritis affecting multiple joints. You may also need to have blood drawn and give a urine sample to send to the laboratory for special tests.

       如果你可能患有感染或影响到多个关节的某些类型的关节炎，你可能需要做实验室检查。你可能要抽点血，和送一份尿液样本到实验室做特殊检查。

X-rays are commonly ordered of both the low back and pelvis. X-rays can give your doctor an idea about how much wear and tear has occurred in the SI joint. X-rays of the lumbar spine and hips are also helpful to rule out problems in these areas that may act and look like SI joint dysfunction.

       通常要拍摄下背部和骨盆的X光片。X光片可以让你的医生了解骶髂关节磨损的程度。腰椎和髋部的X光片也有助于排除这个区域其他看起来像骶髂关节紊乱的病变。

Other radiological tests may be useful as well. The magnetic resonance imaging(MRI) scan can be used to look at the lumbar spine and pelvis in much more detail and to rule out other conditions in the area. The MRI scan uses magnetic waves rather than x-rays and shows a very detailed picture of the soft tissues of the body.

       其他放射学检查可能也有作用。磁共振成像（MRI）扫描可以发现腰椎和骨盆的更多细节，排除该区域的其他疾病。MRI 扫描是使用磁力波的，而不是X射线，其图片能显示身体软组织非常丰富的细节。

A computed tomography (CAT) scan may also be used to show a much more detailed look at the bone of the pelvis and the sacroiliac joint.

       CT扫描可以用来显示骨盆和骶髂关节所含骨骼的更多细节。

A bone scan is useful to see how the skeleton is reacting to any type of “stress,” such as an injury, an infection, or inflammation from arthritis. This test involves injecting chemical “tracers” into your blood stream. The tracers then show up on special spine X-rays. The tracers collect in areas where the bone tissue is reacting strongly to some type of stress to the skeleton, such as arthritis and infection of the SI joint.

       骨扫描对于查看骨骼对于“应激”的反应时很有用，例如创伤、感染，或者关节炎的炎症。这个检查需要注射化学“示踪剂”进入你的血流，然后示踪剂会显示在特殊的脊柱X光片上。骨组织对于某些应激的反应强烈，例如关节炎和骶髂关节的感染，这些反应的区域就会有示踪剂浓集。

The most accurate way of determining whether the SI joint is causing pain is to perform a diagnostic injection of the joint. Because the joint is so deep, this must be done using X-ray guidance with a fluoroscope (a type of realtime X-ray). Once the doctor places a needle in the joint, an anesthetic is injected into the joint to numb the joint. If your pain goes away while the anesthetic is in the joint, then your doctor can be reasonably sure that the pain you are experiencing is coming from the SI joint.

       确定疼痛是否由骶髂关节引起，最准确的方法是实施诊断性关节注射。因为关节是如此之深，所以必须要利用实时X线透视来引导。医生一旦把针头置入关节，就注入麻醉剂来让关节麻木。如果疼痛在麻醉后消失了，那么你的医生可以合理地确定你正在经历的痛苦来自骶髂关节。

（张弛   译）

张弛，主治医师，本科毕业于温州医科大学。曾在上海长征医院和德国哈雷大学医院进修学习。

技术专长：四肢与脊柱骨折创伤的微创治疗，关节病变与运动损伤的诊治。

门诊时间：周三全天

门诊地点：慈溪市中医医院门诊骨伤科

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