臀部肌筋膜痛的临床与相关解剖学研究

发布时间：2017-12-31 04:17

本文关键词：臀部肌筋膜痛的临床与相关解剖学研究　出处：《南方医科大学》2008年硕士论文　论文类型：学位论文

【摘要】： 目的 1.为临床臀部疼痛的定位及治疗提供解剖学依据; 2.为临床臀中肌筋膜痛的诊断与治疗提供参考依据; 3.为临床骶管注射提供解剖学依据。方法 1.以两侧髂后上棘连线为A线,从四个水平,即C水平(A线下1.5cm)、D水平(A线下3.5cm)、E水平(A线下5.5cm)、F水平(A线下7.0cm),并以通过左右髂嵴最高点的垂线B线为外侧界,对12具成人防腐尸体的臀大肌、臀中肌、梨状肌的解剖位置进行观测; 2.(1)选取正常成人70例(男40例,女30例),取同侧臀部臀大肌、梨状肌常见压痛点各一个,臀中肌压痛点四个(记为1、2、3、4,见附图),以约5Kg拇指压力分别按压相应位置,以VAS疼痛评分表记录相应疼痛值;(2)选取臀中肌筋膜痛病人40例(男18例,女22例),按照(1)方法及结果(臀中肌选取(1)结果中压痛值最高点)分别记录相应疼痛值。所得数据用SPSS13.0进行分析; 3.在112例成人干燥骶骨标本上观察骶管裂孔的形态,测量两骶角距离、骶管裂孔矢状径、骶管裂孔上缘与尾骨上缘距离、骶管裂孔深度,按照骶管裂孔的形状、高度、骶角对称与否、两骶角同高与否、变异进行分类,结果进行统计学处理。结果 1.在四个水平上均可见臀大肌与臀中肌,梨状肌多数见于E和F两个水平上。 2.(1)在正常成人臀部六个压痛点处压痛值以梨状肌压痛点疼痛值最高,臀大肌最低,臀中肌四点压痛值以2点最高(2＞1＞4＞3),与梨状肌压痛值对比无显著性差异;臀中肌1、3、4点压痛值与梨状肌压痛值对比均有显著性差异,三点压痛值低于梨状肌;(2)臀中肌筋膜痛病人臀中肌2点与梨状肌压痛点压痛值对比有显著性差异(P＜0.05),臀中肌2点压痛值高于梨状肌。 3.骶管裂孔形状多为长尖形与不规则形;高度多数为骶裂至S_4;两骶角对称、同高者较多,不对称者以偏左者为主;骶骨变异以尾骨骶化者占多数;男女两骶角距离有显著性差异(P＜0.05),男性两骶角距离比女性大。结论 1.临床上臀部疼痛大多可能是臀中肌筋膜痛,而并非梨状肌综合征。 2.(1)正常成人臀中肌压痛以2点最高(2＞1＞4＞3),与梨状肌压痛值相当;(2)臀中肌筋膜痛患者臀中肌压痛值大于梨状肌,临床臀部疼痛并非多为梨状肌综合征,应结合相应压痛位置等以明确诊断; 3.骶管裂孔变异较大,临床骶管注射时应参照上述指标以及相关体征以做到准确的操作,获得良好的疗效。
[Abstract]:objective
1. to provide anatomical basis for the localization and treatment of clinical hip pain.
2. to provide a reference for the diagnosis and treatment of the clinical myofascial pain of the gluteus medius.
3. provide anatomical basis for the injection of the sacral canal.
Method
1. on both sides of the posterior superior iliac spine to connect to the A line, from four levels, namely, the level of C (A 1.5cm line (A line), the level of D 3.5cm E (A), the level of the line 5.5cm), the level of F (A line 7.0cm), and through the left and right iliac crest vertical. The B line as the lateral boundary, the gluteus maximus of 12 adult cadavers, gluteal muscle, observation of the anatomical location of piriformis;
2. (1) selected 70 cases of normal adults (male 40 cases, female 30 cases), the ipsilateral hip gluteus, piriformis muscle tenderness points in each one, middle gluteal muscle tenderness point four (denoted as 1,2,3,4, see Figure), with about 5Kg thumb pressure were pressed to the corresponding position. VAS pain score recorded the corresponding token value of pain; (2) selecting gluteal myofascial pain in 40 patients (male 18 cases, female 22 cases), (1) according to the methods and results (selected the gluteus medius (1) the highest point press pain) recorded the corresponding value of pain were analyzed by SPSS13.0 obtained respectively. Data;
3. in 112 cases of adult dry sacrum specimens to observe the shapes of the sacral hiatus, measuring two sacral angle distance, sagittal diameter of the sacral hiatus, the sacral hiatus on the edge and the upper edge of the coccyx distance, the depth of the sacral hiatus, according to the height of the sacral hiatus, sacral angle shape, symmetry or not, the two sacral angle with high variation or not, the classification, the results were analysed statistically.
Result
1. at four levels, the gluteus maximus and the gluteus medius were seen, and the piriform muscles were mostly seen on the two levels of E and F.
2. (1) in six normal adult hip pain point tenderness to the piriformis muscle tenderness pain was the highest, the gluteus medius is lowest, four points to 2 points (the highest value of tenderness 2 > 1 > 4 > 3), no significant difference between values and piriformis muscle tenderness; hip in 1,3,4 muscle tenderness values had significant difference compared with the piriformis muscle tenderness, three points below the piriformis muscle tenderness; (2) the middle gluteal myofascial pain patients with gluteal muscle 2 and piriformis muscle tenderness tenderness compared had significant difference (P < 0.05), middle gluteal muscle 2 tenderness point is higher than the value of the piriformis muscle.
The 3. sacral hiatus shape as long pointed and irregular shape; height of most sacral hiatus to S_4; two sacral angle symmetry, with high rate of asymmetry in the left main sacrum sacral coccyx; variation to the majority; there was significant difference between male and female two sacral angle distance (P < 0.05), male two sacral angular distance is larger than female.
conclusion
1. most of the clinical hip pain may be the fascia pain of the gluteus medius, rather than the piriformis syndrome.
2. (1) the median gluteal muscle tenderness of normal adults was the highest at 2 points (2 > 1 > 4 > 3), which was similar to that of the piriformis muscle. (2) the median gluteal muscle tenderness of the gluteus medius myofascial pain patients was greater than that of the piriformis muscle. The clinical hip pain was not mostly piriformis syndrome.
3. the cleavage of the sacral canal has a large variation. In clinical sacral canal injection, the above indexes and related signs should be referred to achieve accurate operation, and a good effect is obtained.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R686;R322

【参考文献】