Sacroiliac Joint Dysfunction

骶髂關節(jié)紊亂

A Patient’s Guide to Sacroiliac Joint Dysfunction

骶髂關節(jié)紊亂患者指南

Treatment

治療

What treatment options are available?

       可以采取什么治療措施,？

Nonsurgical Treatment

非手術治療

Doctors often begin by prescribing nonsurgical treatment for SI joint dysfunction. In some cases, doctors simply monitor the patient’s condition to see if symptoms improve. Anti-inflammatory medications, such as ibuprofen and naproxen, are commonly used to treat the pain and inflammation in the joint. Acetominiphen (for example, Tylenol) can be used to treat the pain, but it will not control the inflammation.

       對于骶髂關節(jié)紊亂，醫(yī)生一開始常常采取非手術治療,。對于一些病例,，醫(yī)生僅僅采取觀察,，看看癥狀是否會好轉,。抗炎藥物被普遍用于治療關節(jié)疼痛和炎癥,，例如布洛芬和萘普生,。對乙酰氨基酚（例如撲熱息痛）可以用于鎮(zhèn)痛，但不能控制炎癥,。

Your doctor may ask that you rest your back by limiting your activities. The purpose of this is to help decrease inflammation and calm the muscle spasm. Some patients benefit from wearing a special brace called a sacroiliac belt. This belt wraps around the hips to hold the sacroiliac joint tightly together, which may ease your pain.

      醫(yī)生可能會要求你限制活動來讓背部得到休息,。目的是幫助削弱炎癥，緩解肌肉痙攣,。佩戴一種特殊支具也可以讓一些患者得到益處,。這種環(huán)繞髖部的帶子叫做骶髂固定帶，將骶髂關節(jié)緊束在一起,，可以減輕疼痛。

Patients often work with a physical therapist. After evaluating your condition, a therapist can assign positions and exercises to ease your symptoms. The therapist may design an exercise program to improve the strength and control of your back and abdominal muscles. Some therapists are trained in manipulative techniques that attempt to treat the pain in this manner. You may be able to learn how to adjust your SI joint yourself and ease the symptoms. If your physical therapist is not trained in manipulation, he/she may be able to suggest a chiropractic physician or osteopathic physician in your area who can provide this treatment.

       患者經(jīng)常要配合物理治療師的治療,。評估了你的病情之后,，治療師會給你安排一些姿勢要求和鍛煉方式來緩解癥狀。治療師可能設計一個鍛煉計劃來增強你的力量和對腹背肌肉的控制力,。有些治療師受過手法治療的培訓,，會嘗試以這種方式治療疼痛。你可能會學到如何自我調(diào)整骶髂關節(jié)來緩解癥狀,。如果你的物理治療師沒有受過手法治療的培訓,，他/她可能會建議你去找你所在區(qū)域的整脊醫(yī)師或者骨科醫(yī)生，他們可以提供這種治療,。

If conservative treatment is unsuccessful, injections may be suggested by your doctor. As described above, injections are used primarily to confirm that the pain is coming from the SI joint. A series of cortisone injections may be recommended to try to reduce the inflammation in and around the SI joint. Cortisone is a powerful anti-inflammatory medication that is commonly used to control pain from arthritis and inflammation. Other medications have been injected into the joint as well. A chemical called hyaluronic acid has been used for years to treat osteoarthritis of the knee. This chemical is thought to reduce pain due to its lubricating qualities and the fact that it nourishes the articular cartilage in the synovial joints. The true mechanism of action remains unknown, but it has been used with some success in the SI joint. All of these injections are temporary and are expected to last several months at the most.

       如果保守治療不成功,，醫(yī)生可能會建議注射療法。如上文所述,，注射療法主要用于確認疼痛是否來自骶髂關節(jié),。一系列的可的松注射劑被推薦用于緩解骶髂關節(jié)內(nèi)及其周圍的炎癥?？傻乃墒菑姶蟮南姿?，常用來控制源于關節(jié)炎和炎癥的疼痛。還有其他一些藥物也被用于關節(jié)內(nèi)注射,。一種叫做透明質(zhì)酸的化學物質(zhì)已多年來用于膝關節(jié)的骨關節(jié)炎,。這種化學物質(zhì)被認為可以減少疼痛，因為其具有潤滑性能,，并且可以滋養(yǎng)滑膜關節(jié)的關節(jié)軟骨,。其真正的作用機制仍然不明了,，但曾在骶髂關節(jié)的應用上取得了一些成功。所有這些注射的作用都是暫時的,，預計最長可以維持幾個月,。

Related Document: A Patient’s Guide to Sacroiliac Joint Injections

相關閱讀：骶髂關節(jié)注射療法的患者指南（翻譯招募中，有意者留言）

Another procedure that has been somewhat successful is called radiofrequency ablation. After a diagnostic injection has confirmed that the pain is coming from the SI joint, the small nerves that provide sensation to the joint can be “burned” with a special needle called a radiofrequency probe. In theory, this destroys any sensation coming from the joint, making the joint essentially numb. This procedure is not always successful. It is temporary but can last for up to two years. It can be repeated if needed.

       另一種被稱為射頻消融的治療方法也已取得了一定的成功,。通過診斷性注射確認疼痛來自骶髂關節(jié)后,，用一個特殊的稱為射頻探頭的針去'燒灼'掉支配關節(jié)感覺的小神經(jīng)。理論上這會破壞關節(jié)的所有感覺,，使關節(jié)處于基本上麻木的狀態(tài),。這個治療并不總是成功。它的效果并非永久,，但可以持續(xù)長達兩年,。如果需要的話，可以重復治療,。

Surgery

手術

Surgery may be considered if other treatments don’t work. Surgery consists of fusing the painful SI joint. A fusion is an operation where the articular cartilage is removed from both ends of the bones forming the joint. The two bones are held together with plates and screws until the two bones grow together, or fuse, into one bone. This stops the motion between the two bones and theoretically eliminates the pain from the joint.

       如果其他治療無效,，可能要考慮手術。手術是把疼痛的骶髂關節(jié)融合起來,。融合手術是把兩側關節(jié)面的關節(jié)軟骨刮除,，再用鋼板和螺釘把兩側的骨骼拉在一起，直到骨骼愈合,。這樣兩塊骨頭之間的活動就停止了,，理論上可以消除關節(jié)疼痛。

This is a big operation and is not always successful at relieving the pain. The operation is not commonly performed unless the pain is debilitating. SI joint pain is seldom this severe.

       這是一個大手術,，但并不總是能成功地緩解疼痛,。除非疼痛讓人衰弱，否則一般不做這個手術,。但是骶髂關節(jié)疼痛很少會這么嚴重,。

Rehabilitation

康復

What should I expect as I recover?

       在我的恢復過程中，我應該期待什么呢,？

Nonsurgical Rehabilitation

非手術治療后的康復

Doctors often recommend physical therapy for patients with SI joint dysfunction. Patients are normally seen a few times each week for four to six weeks. In severe and chronic cases, patients may need a few additional weeks of care.

       對于骶髂關節(jié)紊亂的患者,，醫(yī)生往往建議物理治療?；颊咄ǔＣ恐苤委煍?shù)次,，持續(xù)四到六周。對于嚴重的和慢性的情況,，患者可能需要額外數(shù)周的治療,。

When movement of a joint is limited, the pain and symptoms of SI joint dysfunction may worsen. Getting more motion can give you the relief you need for daily activities. If you don’t have full range of motion, your therapist has several ways to help you get more movement including joint manipulation, stretching, and exercises. Active movement and stretching as part of a home program can also help restore movement and get you better faster.

       如果身體關節(jié)活動受限，骶髂關節(jié)的疼痛和其他癥狀會加重,。取得更好的活動度會讓你的日常生活更舒適,。如果你沒有完全的活動度,，你的治療師會有多種方法幫助你取得改善，包括關節(jié)按摩,、拉伸和鍛煉,。包含了主動活動和拉伸練習的家庭計劃也能幫助重建活動度，并讓你加速康復,。 

Therapists commonly prescribe a set of stretches to improve flexibility in the muscles of the trunk, buttocks, and thighs. In addition to the treatment you receive by your therapist, you may be given ways to help your own SI joint if your pain returns. These exercises usually require that you position your hip and pelvis in a certain way and either stretch or contract and relax specific muscles. Follow the instructions of your therapist when doing these exercises.

       治療師通常會制訂一整套的拉伸運動來提高軀干,、臀部和大腿肌肉的柔韌性。治療師除了對你的治療之外,，可能還教你一些方法,，來幫助你在疼痛復發(fā)的時候自己控制骶髂關節(jié)。這些練習通常需要你以某種方式調(diào)整髖部和骨盆的位置,，拉伸或收縮和放松特定肌肉,。請按照您的治療師的指示做這些練習。

If the SI joint has too much mobility and problems keep coming back, you may need extra help to stabilize the SI joint. You may be issued a SI belt to stabilize the joint. A belt like this can often ease pain enough to let you exercise comfortably.

       如果骶髂關節(jié)活動度太大,，那么問題又來了,。你可能在穩(wěn)定骶髂關節(jié)方面需要額外的幫助。你可能會需要骶髂固定帶來穩(wěn)定關節(jié),。像這樣的帶子足以緩解疼痛,，讓你舒適地開展鍛煉。

You’ll learn some exercises to help you build strength, muscle control, and endurance in the muscles that attach around the SI joint. Unfortunately, few muscles actually connect to both the sacrum and the pelvis. Key muscles to work are the gluteus maximus, as well as the abdominal and low back muscles.

       你將學習一些鍛煉方式來幫助你增強力量,、肌肉控制力和骶髂關節(jié)周圍肌肉的耐力。不過,，在骶骨和盆骨上都有附著點的肌肉不多,。起關鍵作用的肌肉是臀大肌，以及腹部和下背部的肌肉,。

動畫：骶髂關節(jié)功能紊亂

After Surgery

手術后的康復

You will normally need to wait at least six weeks before beginning a rehabilitation program after having SI joint fusion surgery. You should plan on attending therapy sessions for six to eight weeks. Expect full recovery to take up to six months.

       你通常要在骶髂關節(jié)融合手術后至少6周才可以開始康復訓練,。你要計劃參加一個6到8周的療程。預計完全康復需要長達6個月,。

During therapy after SI joint surgery, your therapist may use treatments such as heat or ice, electrical stimulation, massage, and ultrasound to help calm your pain and muscle spasm. Then you’ll begin learning how to move safely with the least strain on the healing area.

       在骶髂關節(jié)手術后的治療期間,，你的治療師可能會采用諸如熱療、冷療,、電刺激,、按摩和超聲等等治療手段，來緩解你的疼痛和肌肉痙攣,。然后你會開始學習如何安全地活動,，對正在愈合的區(qū)域帶來最少的張力。

As your rehabilitation program evolves, you’ll begin doing more challenging exercises. The goal is to safely advance your strength and function.

       隨著康復計劃的進展,，你將開始做更具挑戰(zhàn)性的運動,。目標是安全地提高力量和改善功能,。

As your therapy sessions come to an end, your therapist helps you get back to the activities you enjoy. Ideally, you’ll be able to resume your normal activities. You may need guidance on which activities are safe or how to change the way you go about your activities.

       當你的療程告終，治療師會幫助你回到以前喜好的活動,。理想情況下,，你將能夠恢復你的正常活動,。您可能需要一些指導,，關于哪些活動是安全的，或者如何改變你的活動方式,。

When treatment is well under way, regular visits to your therapist’s office will end. Your therapist will continue to be a resource. But you’ll be in charge of doing your exercises as part of an ongoing home program.

       如果康復治療進行良好,，那就不需要定期去拜訪你的治療師。你還是可以去尋求治療師的指導,。但你可以監(jiān)督自己完成正在進行的家庭計劃中的訓練,。

（張弛   譯）

張弛，主治醫(yī)師,，本科畢業(yè)于溫州醫(yī)科大學,。曾在上海長征醫(yī)院和德國哈雷大學醫(yī)院進修學習。

技術專長：四肢與脊柱骨折創(chuàng)傷的微創(chuàng)治療,，關節(jié)病變與運動損傷的診治,。

門診時間：周三全天

門診地點：慈溪市中醫(yī)醫(yī)院門診骨傷科

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