肌骨超声引导下手法治疗产后骶髂关节错缝的临床观察

Clinical Observation of Musculoskeletal Ultrasound Guided Manipulative Reduction for Treatment of Postpartum Sacroiliac Joint Dislocation

【目的】观察肌骨超声引导下手法治疗产后骶髂关节错缝的临床疗效,为提高手法治疗产后骶髂关节错缝的准确性和有效性提供新的方向。【方法】将54例产后骶髂关节错缝患者随机分为治疗组和对照组,每组各27例。治疗组患者给予肌骨超声引导下的定点手法理筋复位综合治疗,对照组患者给予传统手法理筋复位综合治疗。隔天治疗1次,5次为1个疗程,共治疗1个疗程。观察2组患者治疗前后Oswestry功能障碍指数评分和血清磷酸肌酸激酶(CK)水平的变化情况,并评价2组患者的临床疗效。【结果】(1)治疗过程中,治疗组脱落2例,最终纳入25例;对照组脱落1例,最终纳入26例。(2)治疗1个疗程后,治疗组的总有效率为100.0%(25/25),对照组为92.3%(24/26),组间比较(秩和检验),治疗组的疗效明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者Oswestry功能障碍指数评分均较治疗前明显降低(P<0.05),且治疗组的降低作用明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者血清CK值均较治疗前明显降低(P<0.05),且治疗组的降低作用有优于对照组的趋势,但差异无统计学意义(P>0.05)。【结论】肌骨超声引导下手法治疗产后骶髂关节错缝疗效确切,能有效改善患者的症状、体征及功能障碍,其疗效优于传统手法治疗。

Objective To observe the clinical effect of musculoskeletal ultrasound guided manipulative reduction for the treatment of postpartum sacroiliac joint dislocation,and to provide thoughts for enhancing the accuracy and effectiveness of manipulative reduction in treating postpartum sacroiliac joint dislocation. Methods A total of 54 patients of postpartum sacroiliac joint dislocation were randomly divided into treatment group and control group,27 cases in each group. The patients in the treatment group were treated with tendon-soothing manipulation under the guidance of musculoskeletal ultrasound,while the patients in the control group were treated with conventional tendon-soothing manipulation. The treatment for both groups was performed once every other day, 5 times constituted a course of treatment,and the treatment covered one course. Before and after treatment,the Oswestry dysfunction index scores and serum creatine kinase(CK) level in the two groups were observed. After treatment,the clinical efficacy of the two groups was evaluated. Results(1)During the trial,2 cases from the treatment group and one case from the control group dropped out,and a total of 25 cases in the treatment group and 26 cases in the control group finished the trial.(2)After treatment for one course,the effective rate was 100.0%(25/25)in the treatment group and was 92.3%(24/26)in the control group,the treatment group had stronger efficacy than the control group and the difference showed by rank sum test was statistically significant(P<0.05).(3)After treatment,the Oswestry dysfunction index scores in both groups were decreased in comparison with those before treatment(P<0.05), and the decrease in the treatment group was superior to that in the control group, the difference being statistically significant(P<0.05).(4)After treatment,the serum CK level in both groups was decreased in comparison with that before treatment(P<0.05),but the decrease in the treatment group only tended to being superior to that in the control group, the difference being not statistically significant(P>0.05).Conclusion Musculoskeletal ultrasound guided manipulative reduction exerts certain effect for the treatment of postpartum sacroiliac joint dislocation through effectively relieving the clinical symptoms and signs,and improving the dysfunction of postpartum sacroiliac joints. Its effect is stronger than the conventional manipulation.