超声在正骨手法治疗产后耻骨联合分离症中的应用

Application of ultrasound in treating postpartum pubis symphysis diastasis by bone setting manipulation

目的:探讨超声应用于正骨手法治疗产后耻骨联合分离症疗中的应用价值。方法:对2017年6月至2021年1月在中国中医科学院望京医院门诊诊断产后耻骨联合分离症30例患者(病例组)进行回顾性分析,年龄21~43(33.0±3.5)岁,主要临床表现为翻身、行走等活动障碍,所有患者采用正骨手法治疗,且治疗前后采用视觉模拟评分(visual analogue scale,VAS)法及超声检查分别对疼痛和耻骨联合分离程度进行评定。正常组选取欲取子宫内节育器且行常规骨盆正位X线片检测的绝经期妇女30例,年龄49~59(54.0±2.9)岁,行超声及X线测量耻骨联合间隙的宽度。结果:正常组中超声测量妇女的耻骨联合宽度(5.2±1.7)mm,X线测量耻骨联合宽度(5.0±2.1)mm,超声与X线测量耻骨联合宽度比较差异无统计学意义(P>0.05)。病例组手法治疗前超声测量耻骨联合宽度(9.5±1.8)mm,VAS 6.05(5.27,6.80)分,手法治疗后耻骨联合宽度(5.8±1.3)mm,VAS 0(0,0)分,手法治疗前后耻骨联合宽度及VAS比较差异均有统计学意义(P<0.05)。结论:超声安全无放射性、易重复多次检查,能清晰显示耻骨联合周围软骨、韧带及骨质结构,更适合做为产后耻骨联合分离症的影像学诊断方法,为临床正骨手法治疗产后耻骨联合分离症的疗效评定提供定量的影像学依据。

Objective:To explore application value of ultrasound in treating postpartum pubis symphysis diastasis by bone setting manipulation. Methods:Retrospective analysis was performed on 30 patients(case group) with postpartum pubis symphysis diastasis diagnosed in Wangjing Hospital,China Academy of Chinese Medical Sciences from June 2017 to January 2021,aged from 21 to 43 years old,with an average of(33.0±3.5) years old. The main clinical manifestations were mobility disorders such as turning over and walking,and all patients were treated by bone setting manipulation. Before and after treatment,pain and degree of pubic symphysis separation were evaluated by visual analogue scale(VAS) and ultrasonography. In normal group,30 menopausal women aged from 49 to 59 years old with an average of(54.0±2.9) years old who wanted to remove intra uterine device(IUD) and were underwent conventional pelvic plain radiographswere selected,and the width of pubic symphysis space was measured by ultrasound and plain radiographs. Results:In normal group,the width of pubic symphysis was about(5.2±1.7) mm by ultrasonography,X-ray measurement was(5.0±2.1) mm,and showed no difference(P>0.05).In case group,the width of pubic symphysis measured by ultrasound before manipulation was about(9.5±1.8) mm,VAS was 6.05(5.27,6.80) scores;while the width of pubic symphysis measured by ultrasound before manipulation was about(5.8±1.3)mm,VAS was 0(0,0) scores,and there were statistical difference before and after manipulation(P<0.05). Conclusion:Ultrasound is examation method with safe,non radioactive,easy to repeat for many times,could clearly show cartilage,ligament and bone structure around pubic symphysis,and is more suitable for the imaging diagnosis of postpartum pubis symphysis diastasis,which provide quantitative imaging basis for clinical evaluation of the curative effect of bone setting manipulation in treating postpartum pubis symphysis diastasis.