磁共振分析初产妇骶髂关节与耻骨联合骨髓水肿的变化及其临床意义

Analysis of the changes by magnetic resonance imaging in pelvic bone marrow edema of sacroiliac joint and pubic symphysis in primiparas and corresponding clinical significance

目的通过足月初产妇产前和产后磁共振(MRI)数据分析骶髂关节及耻骨联合关节间隙,探讨关节骨髓水肿与骨盆疼痛是否相关。方法对2014年1月至2017年1月在南方医科大学南方医院产检行盆腔MRI的97例足月初产妇数据进行回顾性分析,入组病例均做2~3次盆腔MRI检查,包括晚孕期、产后42d和(或)产后6~8个月。按照阴道分娩或者剖宫产将入组病例分为经阴道分娩组(72例)和剖宫产组(25例),分析比较MRI图像上晚孕及产后骶髂关节与耻骨联合是否存在骨髓水肿和耻骨联合骨折,然后电话随访入组病例,记录孕前、孕晚期及产后是否出现骨盆疼痛。同期收集120例年轻未分娩女性盆腔MRI图像作为对照。结果 (1)产后MRI骶髂关节及耻骨联合骨髓水肿经阴道分娩组高于剖宫产组。(2)分娩后6~8个月时,初产妇骶髂关节及耻骨联合骨髓水肿基本恢复。(3)初产妇骶髂关节痛与骶髂关节骨髓水肿有关;然而耻骨联合痛与耻骨联合骨髓水肿无关,与耻骨联合骨折有关。结论初产妇出现的骶髂关节骨髓水肿是关节的一种炎性改变,可能与初产妇骶髂关节痛有关,经阴道分娩后产妇骨盆骨髓水肿风险增加,对于初产妇骶髂关节疼痛,在临床的诊疗中应关注骶髂关节骨髓水肿情况。

Objective To explore the pelvic marrow edema of sacroiliac joint and pubic symphysis at fullterm pregnant female before and after delivery based on Magnetic Resonance Image and its relationship with pelvic pain from pregnancy to postpartum,and to study effects of pregnancy and childbirth on pelvis. Methods We did retrospective investigation from January 2014 to January 2017 in the 97 cases fullterm pregnant female underwent 2 or 3 times pelvic MRI in Nanfang Hospital of Southern Medical University.MRI examination was performed at late term pregnancy,42 days postpartum and/or 6-8 months postpartum. According to mode of delivery,they were separated to vaginal delivery group（72 cases）and cesarean group（25 cases）.Recording whether there was marrow edema of the sacroiliac joint and pubic symphysis and whether there was pubic symphysis fracture on its MRI,and follow-ups were made in all patients about whether they had history of pelvic pain before and during pregnancy and postpartum by telephone. The pelvic MRI of 120 nulliparous female were collected as control.Results （1）After vaginal delivery,pubic symphysis bone marrow edema was higher than cesarean section primipara.（2）Bone marrow edema of sacroiliac joint and pubic symphysis can recover in postpartum 6-8 months.（3）The bone marrow edema of the sacroiliac joint were significantly related to pain of primipara＇s sacroiliacjoint,but marrow edema of pubic symphysis had no correlation with pubic symphysis pain,but pubic symphysis fracture was significantly correlated with its pain.Conclusion The bone marrow edema of sacroiliac joint is joint inflammation,and significantly associated with primipara＇s sacroiliac joint pain in late pregnancy and postpartum. So When dealing with primipara＇s sacroiliac joint pain we should pay enough attention to sacroiliac joint bone marrow edema.