Mr Sun Feng’s clinical observation on sciatica shows that over 85% of sciatica cases are caused by dislocation of sacroiliac joint


孫鋒分享一項有關坐骨神經痛的臨床觀察,指出逾八成半坐骨神經痛均由骶髂關節錯位引致

Date: 24 Nov 2015 (Tuesday)

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HKBU clinical study shows that over 85% of sciatica cases are caused by dislocation of sacroiliac joint

浸大臨床觀察顯示逾八成半坐骨神經痛由骶髂關節錯位引致

A clinical observation on sciatica conducted by the School of Chinese Medicine (SCM) revealed that 86.29% of the cases resulted from the dislocation of sacroiliac joint whereas only 7.26% of the cases are related to lumbar disc protrusion. Prior to this study, lumbar disc protrusion was commonly considered to be the clinical casual factor for this problem.
 
Dislocation of sacroiliac joint is also known as dislocation of the pelvis. People who sit or stand for long periods, as well as those who perform excessive heavy manual labour are prone to sciatica. Mr Sun Feng, Senior Lecturer of the Clinical Division of SCM, conducted a clinical observation on 248 sciatica patients who attended medical consultations during the period from March 2008 to January 2015 at HKBU Chinese medicine clinics and some clinics run by members of the Hong Kong Traditional Chinese Medicine Orthopaedic and Traumatic Association. The 94 male and 154 female patients, with ages ranging from 16 to 77, have been suffering from pain for a period of 2 hours to 20 years.
 
The 248 patients were physically examined in accordance with the diagnostic standards for “lumbar disc protrusion”, “dislocation of sacroiliac joint” and “spinal compression”. It was found that 214 of the patients (86.29%) experienced pain due to “dislocation of sacroiliac joint”; nine of them (3.63%) had the symptoms of both “lumbar disc protrusion” and “dislocation of sacroiliac joint” at the same time; 18 of the cases (7.26%) encountered the problems of “lumbar disc protrusion” while the remaining seven patients (2.82%) were suffering from “spinal compression”. The observation pointed to a relationship between sciatica and dislocation of pelvis.
 
In elucidating the relationship between dislocation of sacroiliac joint and sciatica, Mr Sun Feng said that the dislocation would give rise to unequal leg length which would further aggravate the condition of the joints connecting the kinematic chain of pelvic, hip, knee and ankle. At the same time, the thirty-odd groups of muscles and tendons responsible for maintaining pelvic stability would also lose balance, resulting in stretch and compression of  the sciatic nerves running along the affected areas, thereby causing sciatic pain from the waist and hip extending to the legs. Severe cases may result in foot paralysis.
 
The present observation is a further analysis of a statistical analysis conducted by Mr Sun Feng on Hong Kong Chinese medicine out-patient lumbocrural pain occurrence. In that statistical analysis, it was found that patients who were suffering from sacroiliac joint dislocation also experienced pelvic pain, knee pain, ankle pain, sciatica or paralysis, frequent micturition or abdominal pain. Often, patients incorrectly consult doctors on these symptoms instead of looking into the causal factor. Mr Sun suggested that medical practitioners should conduct physical examination on sacroiliac joint with a view to provide appropriate therapy for patients.
 

中醫藥學院完成的一項有關坐骨神經痛的臨床觀察顯示,86.29%病例的發病原因是由於「骶髂關節錯位」,只有7.26%病例屬於臨床上常說的「腰椎間盤脫出症」。
 
「骶髂關節錯位」常被稱為「盆骨錯位」,一般而言,長期坐立工作或過度勞動的人特別容易引發坐骨神經痛。中醫藥學院臨床部高級講師孫鋒分析了248個於2008年3月至2015年1月分別前往浸大中醫藥診所和部份香港骨傷學會會員診所就診的坐骨神經痛病例,包括94名男病人和154名女病人,年齡介乎16至77歲,發病時期由兩小時至20年。
 
是次臨床觀察根據「腰椎間盤脫出症」、「骶髂關節錯位」和「腰椎滑脫」的診斷標準對248名病人進行檢查,結果顯示214人 (86.29%) 因「骶髂關節錯位」導致坐骨神經痛;9人 (3.63%) 同時出現「腰椎間盤脫出症」和「骶髂關節錯位」的症狀;另有18人 (7.26%) 因「腰椎間盤脫出」引致坐骨神經痛;其餘7人 (2.82%) 則因「腰椎滑脫」而發病。此項研究揭示了坐骨神經痛與盆骨錯位的相關性。
 
孫鋒闡釋「骶髂關節錯位」與坐骨神經痛的關連時表示,骶髂關節一旦錯位,會導致雙下肢不等長,進而影響連接骶髂、髖、膝和足踝的運動鏈上各關節受力不平衡,同時維持骨盆穩定的三十多組肌肉及韌帶亦將因此而失去平衡,對行走其間的坐骨神經形成牽拉或卡壓,引致病人坐骨神經疼痛,疼痛部位由腰骶部伸延至臀腿部,情況嚴重的病人甚至會出現足部麻痹。
 
是項臨床觀察是基於孫鋒另一項有關「香港中醫門診腰腿痛發病規律的統計分析」作進一步的分析。該項統計分析顯示,「骶髂關節錯位」的患者通常可同時伴發髖痛、膝痛、足踝痛、坐骨神經痛或麻痹、尿頻、腹痛等症狀,患者有時甚至以這些症狀為主訴求診。孫鋒建議,臨床上要對這些病人進行骶髂關節檢查,為他們提供合適的治療方案。