妊娠期下腰痛与骨盆痛的生物力学特点研究进展

Biomechanical Characteristics of Pregnancy-related Low Back Pain and Pelvic Pain

下腰痛与骨盆痛是妊娠期妇女的常见主诉。该症状的病因较为复杂,而生物力学的改变是重要的原因之一。腰椎与骨盆周围组织的生物力学改变会影响组织的生化、病理与解剖结构等方面,且常互为因果。妊娠期激素水平的改变使耻骨联合、骶髂关节和腰椎关节突关节等部位的肌肉、韧带松弛,造成脊柱、骨盆失稳;随着妊娠的进展,子宫不断增大以及妇女体质量的增加,骨盆前倾,腰椎前凸,重心前移,腰椎的轴向负荷增大,椎间盘被压缩,可加速椎间盘退变、突出;同时增大的子宫削弱了腹部的肌肉力量,腰背肌被动代偿持续紧张而易疲劳,身体前后力量失衡,由此可引发妊娠期妇女下腰痛与骨盆痛。

Low back pain and pelvic pain is a common complaint among pregnant women. Although the cause of this symptom is a little complicated, the change of body biomechanics is always one of the significant causations. Biomechanical changes of tissue surrounding the lumbar and pelvis often affect the tissue biochemistry,pathology and anatomical structure,and often reciprocal causation. During pregnancy,the change of hormone level relaxes muscles and ligaments of the pubic symphysis,sacroiliac joints and lumbar zygapophysial joints, which brings about spine and pelvic instability; with the progression of pregnancy,increased uterine weight and body weight lead to anterior pelvic tilt,lumbar lordosis,body center of gravity forward,increasing the axial load of the lumbar intervertebral disc. Compressed disc can accelerate the degeneration and protrusion of intervertebral disc. Meanwhile, increased uterus weakens abdominal muscle strength, resulting in low back muscles’ fatigue because of its passive compensatory and continued tension. The muscle strengths of front and back of body are not at the same level,which contributes to low back pain and pelvic pain during pregnancy in women.