中醫治療骶髂關節炎之病例報告

Traditional Chinese Medicine Treatment of Sacroiliitis-A Case Report

10.6516/TJTCM.202103_24(1).0013

鄭群耀(Chun-Yao Cheng)；鄭宜哲(Yi-Che Cheng)

骶髂關節炎 ； 中醫 ； 理中湯加減 ； 針刀療法 ； Sacroiliitis ； Chinese Medicine ； Lizhong Decoction ； Acupotomy

中醫藥研究論叢

24卷1期（2021 / 03 / 30）

157 - 176

繁體中文

骶髂關節失衡（Sacroiliac Joint Dysfunction）通常會引起骶髂關節疼痛症候群，常容易被誤認為脊椎問題或是梨狀肌症候群，最常見疼痛部位位於髂後上棘（Posterior superior iliac spine）附近，然而骶髂關節疼痛並非局限於髂後上棘的疼痛，可能輻射至上腰部（6％），腹股溝（4％），下腹部（2％）。骶髂關節多種症狀被認為是由很多複雜因素共同造成的。根據國外研究發現下背痛患者亦有骶髂關節疼痛問題約是15～25％。台灣尚無公共衛生統計，大約5成民眾受下背痛困擾，其中2成屬骶髂關節疼痛，推測台灣的盛行率約10％。骶髂關節疼痛症候群跟職業上沒有直接相關性，主要是與骶髂關節穩定度有關。治療一般分為保守治療、藥物及手術治療。本病患左側下背臀部痠痛已一年，109年07月29日在台中慈濟醫院神經外科診斷左側骶髂關節炎，之後執行患處神經燒灼手術（高頻熱凝療法Radiofrequency, RF）。術後病人覺得患處疼痛稍許減輕，視覺類比量表（Visual Analogue Scale: VAS）VAS：7－8分，神經燒灼術後效果不佳需要作骶髂關節融合術，因病人對開刀另有考慮，而至台中慈院中醫部傷科治療，使用中藥內服、針刀療法及腰臀核心肌群訓練，經過兩個多月治療，病人疼痛減輕（VAS：2－3分）很多。中醫治療關節炎疼痛有顯著療效，臨床病例上中醫治療骶髂關節炎較不常見，故提出此案例給中醫師治療之參酌。

Sacroiliac joint imbalance usually causes sacroiliac joint pain syndrome, which is often mistaken for spinal problems or piriformis syndrome. The most common pain site is located near the posterior superior iliac spine. Sacroiliac joint pain is not only limited to the pain of the posterior superior iliac spine but also radiate to the upper lumbar (6%), groin (4%), and lower abdomen (2%). According to studies, it is found that patients with lower back pain also suffer from sacroiliac joint pain, which is about 15-25%. There are no public health statistics in Taiwan. About 50% of the people suffer from lower back pain, of which 20% are sacroiliac joint pain. It is estimated that the prevalence rate in Taiwan is about 10%. The sacroiliac joint pain syndrome is related to the stability of the sacroiliac joint. The treatment of sacroiliitis includes conservative treatment, medication and surgical treatment. The patient's left lower back buttock has been sore for a year. On July 29, 109, he was diagnosed with left sacroiliitis at the Department of Neurosurgery, Taichung Tzu Chi Hospital. After that, perform a radiofrequency operation, the patient felt that the pain in the affected area was slightly relieved. Visual Analogue Scale (VAS) 7-8 points. Poor postoperative results require sacroiliac joint fusion. Because the patient has other considerations about surgery, he went to the TCM Traumatology Department of Taichung Tzu Chi Hospital. After more than two months of treatment with traditional Chinese medicine, needle-knife therapy and waist-butt core muscle training, the patient's pain has been reduced a lot. VAS: 2-3 points. Traditional Chinese medicine has a significant effect in treating arthritis pain. The treatment of sacroiliac arthritis by Chinese medicine is relatively uncommon in clinical cases. Therefore, this case is presented for consideration by physicians.

1. （宋）陳言(2019).陳言：三因極一病證方論.北京:人民衛生出版社.
2. （清）張璐(2019).張氏醫通.北京:人民衛生出版社.
3. （清）彭子益(2015).圓運動的古中醫學.台北:文光圖書.
4. （清）鄭壽權(1993).醫法圓通.北京:中國中醫藥出版社.
5. Beal, MC(1982).The sacroiliac problem: Review of anatomy, mechanics, and diagnosis.J Am Osteopath Assoc,81,667-679.
6. Benjamin K. Buchanan, Matthew Varacallo: Sacroiliitis.2020 Aug 11. In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2020 Jan. PMID: 28846269.
7. Casazza, Brian A(2012).Diagnosis and treatment of acute low back pain.American Family Physician,85(4),343-350.
8. Cibulka, MT,Delitto, A(1993).A comparison of two different methods to treat hip pain in runners.J Orthop Sports Phys Ther,17,172-176.
9. Cohen, SP,Abdi, S(2003).Lateral branch blocks as a treatment for sacroiliac joint pain: a pilot study.Reg Anesth Pain Med,28,113-119.
10. Cohen, SP,Chen, Y,Neufeld, NJ(2013).Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment.Expert Rev Neurother,13(1),99-116.
11. Cohen, Steven P.(2005).Sacroiliac Joint Pain: A Comprehensive Review of Anatomy, Diagnosis, and Treatment.Anesth Analg,101,1440-1453.
12. Coy, JT,Wolf, CR,Brower, TD,Winter, WG, Jr(1976).Pyogenic Arthritis of the Sacro-Iliac Joint; longterm follow-up.J Bone Joint Surg,58A,845-849.
13. Cummings, J, Jr(2013).Minimally invasive sacroiliac joint fusion: one-year outcomes in 18 patients.Ann Surg Innov Res,7(1),12.
14. Dreyfuss, P,Michaelsen, M,Pauza, K,McLarty, J,Bogduk, N(1996).The value of medical history and physical examination in diagnosing sacroiliac joint pain.Spine,21,2594-2602.
15. Fortin, JD,Aprill, CN,Ponthieux, B,Pier, J(1994).Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part II: clinical evaluation.Spine,19,1483-1489.
16. Fortin, JD,Dwyer, AP,West, S,Pier, J(1994).Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: asymptomatic volunteers.Spine,19,1475-1482.
17. Greis, A,Berk, J,Gellhorn, AC(2013).Non- interventional treatment options for sacroiliac joint mediated pain: a review.OA Musculoskeletal Medicine,1(1),10.
18. Healy, PJ,Helliwell, PS(2005).Classification of the spondyloarthropathies.Curr Opin Rheumatol,17(4),395-359.
19. Healy, PJ,Helliwell, PS(2005).Classification of the spondyloarthropathies.Curr Opin Rheumatol,17(4),395-399.
20. Jeong, Ui-Cheol,Sim, Jae-Heon,Kim, Cheol-Yong,Gak, Hwang-Bo,Nam, ChanWoo(2015).The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients.Journal of physical therapy science,27(12),3813-3816.
21. Karabacakoglu, A,Karakose, S,Ozerbil, OM,Odev, K(2002).Fluoroscopy-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with ankylosing spondylitis.Acta Radiol,43,425-427.
22. Kim, Kyung-Ah,Jung, Il-Hoon,Park, Se-Hoon,Ahn, Young-Tae,Huh, Chul-Sung,Kim, Dong-Hyun(2013).Comparative analysis of the gut microbiota in people with different levels of ginsenoside Rb1 degradation to compound K.PLoS One,8(4),e62409.
23. Kim, Woong Mo,Lee, Hyung Gon,Jeong, Cheol Won,Kim, Chang Mo,Yoon, Myung Ha(2010).A randomized controlled trial of intraarticular prolotherapy versus steroid injection for sacroiliac joint pain.J Altern Complement Med,16,1285-1290.
24. Kim, Woong Mo,Lee, Hyung Gon,Jeong, Cheol Won,Kim, Chang Mo,Yoon, Myung Ha(2010).A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain.J Altern Complement Med,16(12),1285-1290.
25. Lo, GH,LaValley, M,McAlindon, T,Felson, DT(2003).Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a metaanalysis.JAMA,290,3115-3121.
26. Maugars, Y,Mathis, C,Vilon, P,Prost, A(1992).Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy.Arthritis Rheum,35,564-568.
27. Rupert, Matthew P,Lee, Marion,Manchikanti, Laxmaiah,Datta, Sukdeb,Cohen, Steven P(2009).Evaluation of sacroiliac joint interventions: a systematic appraisal of the literature.Pain Physician,12(2),399-418.
28. Siebelt, M,Agricola, R,Weinans, H,Kim, YJ(2014).The role of imaging in early hip OA.Osteoarthritis Cartilage,22,1470.
29. Simpson, L A,Waddell, J P,Leighton, R K,Kellam, J F,Tile, M(1987).Anterior approach and stabilization of the disrupted sacroiliac joint.J Trauma,27,1332-1339.
30. Slipman, C W,Jackson, H B,Lipetz, J S,Chan, K T,Lenrow, D,Vresilovic, E J(2000).Sacroiliac joint pain referral zones.Arch Phys Med Rehabil,81,334-338.
31. Tile, M(1996).Acute pelvic fracture: I. Caution and classification.JAAOS,1996(4),143.
32. van Wingerden, J P,Vleeming, A,Buyruk, H M,Raissadat, K(2004).Stabilization of the sacroiliac joint in vivo: verification of muscular contribution to force closure of the pelvis.Eur Spine J.,13(3),199-205.
33. Ye, Hua,Wu, Qiong,Zhu, Yuzhen,Guo, Cancan,Zheng, Xuebao(2014).Ginsenoside Rh2 alleviates dextran sulfate sodium-induced colitis via augmenting TGFβ signaling.Mol Biol Rep,41(8),5485-5490.
34. 王超然(2017)。髂關節疼痛症候群。健康世界月刊，57-59。
35. 白明學(2008)。白朮的現代藥理研究與臨床新用。中國中醫藥現代遠端教育，6(6)，609-610。
36. 李克光(2002).金匱要略.台北:知音出版社.
37. 李培生（編）(2011).傷寒論.台北:知音出版社.
38. 孟景春,王新華(2011).黃帝內經素問譯釋.台北:文光圖書.
39. 高學敏(2002).中藥學.北京:中國中醫藥出版社.
40. 張幸初(2015)。下背痛面面觀。臺中醫林季刊，36-38。
41. 張明發,沈雅琴(2011)。甘草及其活性成分抗炎與抗炎機制的研究進展。現代藥物與臨床，26(4)，261-268。
42. 張翅騰,王毅(2018)。COX2-PGE2 調節腫瘤的發生和發展機制研究進展。西南軍醫，20(1)，50-53。
43. 陳榮洲(2003)。李東垣脾胃論元氣陰火學說的研究。中醫藥雜誌，14(1)，1-15。
44. 黎波,馬超英,萬友生(2013)。甘溫除熱法治療膿毒癥（敗血癥）經驗簡介。第十三次全國中西醫結合虛證與老年醫學學術研討會論文集
45. 謝文娟,張志敏,武志娟(2013)。附子理中湯對 D-IBS 大鼠血清 TNF-α、IL-10 的影響。中國中醫急症，22(8)，1287-1288。
46. 嚴雋陶(2003).推拿學.北京:中國中醫藥出版社.
47. 顧芮博,崔俊波(2017)。對於陰火的新認識。光明中醫，32(8)，1090-1092。