中醫治療髂關節炎之病例報告

Traditional Chinese Medicine Treatment of Sacroiliitis-A Case Report

"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.