本文關(guān)鍵詞：臀部肌筋膜痛的臨床與相關(guān)解剖學研究　出處：《南方醫(yī)科大學》2008年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 臀中肌 解剖 疼痛 肌筋膜痛 壓痛點 骶骨 骶管裂孔 骶管注射

【摘要】： 目的 1.為臨床臀部疼痛的定位及治療提供解剖學依據(jù); 2.為臨床臀中肌筋膜痛的診斷與治療提供參考依據(jù); 3.為臨床骶管注射提供解剖學依據(jù)。 方法 1.以兩側(cè)髂后上棘連線為A線,從四個水平,即C水平(A線下1.5cm)、D水平(A線下3.5cm)、E水平(A線下5.5cm)、F水平(A線下7.0cm),并以通過左右髂嵴最高點的垂線B線為外側(cè)界,對12具成人防腐尸體的臀大肌、臀中肌、梨狀肌的解剖位置進行觀測; 2.(1)選取正常成人70例(男40例,女30例),取同側(cè)臀部臀大肌、梨狀肌常見壓痛點各一個,臀中肌壓痛點四個(記為1、2、3、4,見附圖),以約5Kg拇指壓力分別按壓相應(yīng)位置,以VAS疼痛評分表記錄相應(yīng)疼痛值;(2)選取臀中肌筋膜痛病人40例(男18例,女22例),按照(1)方法及結(jié)果(臀中肌選取(1)結(jié)果中壓痛值最高點)分別記錄相應(yīng)疼痛值。所得數(shù)據(jù)用SPSS13.0進行分析; 3.在112例成人干燥骶骨標本上觀察骶管裂孔的形態(tài),測量兩骶角距離、骶管裂孔矢狀徑、骶管裂孔上緣與尾骨上緣距離、骶管裂孔深度,按照骶管裂孔的形狀、高度、骶角對稱與否、兩骶角同高與否、變異進行分類,結(jié)果進行統(tǒng)計學處理。 結(jié)果 1.在四個水平上均可見臀大肌與臀中肌,梨狀肌多數(shù)見于E和F兩個水平上。 2.(1)在正常成人臀部六個壓痛點處壓痛值以梨狀肌壓痛點疼痛值最高,臀大肌最低,臀中肌四點壓痛值以2點最高(2＞1＞4＞3),與梨狀肌壓痛值對比無顯著性差異;臀中肌1、3、4點壓痛值與梨狀肌壓痛值對比均有顯著性差異,三點壓痛值低于梨狀肌;(2)臀中肌筋膜痛病人臀中肌2點與梨狀肌壓痛點壓痛值對比有顯著性差異(P＜0.05),臀中肌2點壓痛值高于梨狀肌。 3.骶管裂孔形狀多為長尖形與不規(guī)則形;高度多數(shù)為骶裂至S_4;兩骶角對稱、同高者較多,不對稱者以偏左者為主;骶骨變異以尾骨骶化者占多數(shù);男女兩骶角距離有顯著性差異(P＜0.05),男性兩骶角距離比女性大。 結(jié)論 1.臨床上臀部疼痛大多可能是臀中肌筋膜痛,而并非梨狀肌綜合征。 2.(1)正常成人臀中肌壓痛以2點最高(2＞1＞4＞3),與梨狀肌壓痛值相當;(2)臀中肌筋膜痛患者臀中肌壓痛值大于梨狀肌,臨床臀部疼痛并非多為梨狀肌綜合征,應(yīng)結(jié)合相應(yīng)壓痛位置等以明確診斷; 3.骶管裂孔變異較大,臨床骶管注射時應(yīng)參照上述指標以及相關(guān)體征以做到準確的操作,獲得良好的療效。
[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.

【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2008
【分類號】：R686;R322

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