慢性骨筋膜间隔综合征所致下腰痛的临床诊治

目的 :探讨由腰骶部慢性骨筋膜间隔综合征所致慢性腰痛的临床诊治方法。方法 :腰骶部慢性骨筋膜间隔综合征所致慢性腰痛患者 6 5例 ,男 31例 ,女 34例 ,年龄 18～ 6 6岁 ,慢性腰痛时间 2～ 4 2年 ,平均 19年。诊断采用竖脊肌内压测定 ,治疗采用腰骶部骨筋膜间隔切开减压的方法。结果 :6 5例患者术后经 1～ 2 8个月、平均 1.5个月康复功能训练后 ,术前久坐、久站、长时间行走、长时间固定姿势卧床及长时间弯腰后腰痛症状及阳性体征 ,5 7例消失 ,8例缓解。术前腰骶部骨筋膜间隔内压在静息、运动中和运动后 6min内统计结果分别为 (1.4± 0 .1)、(2 4 .9± 1.5 )和 (1.8± 0 .2 )kPa ,术后分别为 (0 .9± 0 .1)、(2 1.6± 1.6 )和 (0 .9± 0 .1)kPa(P <0 .0 5 )。超声多普勒表明腰骶部骨骼肌内最大血流速度和平均血流速度较术前分别增加 (0 .17± 0 .0 2 )kHz和 (0 .0 9± 0 .0 1)kHz(P <0 .0 5 )。结论 :采用骨筋膜间隔内压测定的方法诊断腰骶部慢性骨筋膜间隔综合征所致慢性腰痛和采用骨筋膜间隔切开减压的方法治疗该疾病是可行的。     

椎间盘造影结合亚甲蓝注射治疗椎间盘源性下腰痛的初步疗效观察

目的:收集行椎间盘造影结合椎间盘内亚甲蓝注射治疗的椎间盘源性腰痛患者的术后及1年后随访资料进行分析,评估该技术的临床治疗效果.方法:2005年8月～2008年11月,我们对67例诊断为椎间盘源性腰痛并经过正规保守治疗3个月无效的患者,采用椎间盘造影结合椎间盘内亚甲蓝注射治疗治疗.通过对患者术后第2天与1年后视觉疼痛评分比例尺和SF-36躯体疼痛调查问卷评分分析,评价椎问盘内亚甲蓝注射治疗对椎间盘源性腰痛的治疗效果.结果:所有67例患者中,术后2天VAS得分较术前平均降低了4.33,SF-36问卷评分平均上升了20.11;术后获得1年随访的47例患者中VAS得分较术前平均降低了4.16,SF-36问卷评分平均上升了17.55.术后2天内及术后1年VAS得分和SF-36问卷评分与术前相比存在显著性差异(P＜0.001).治疗及随访期间未发生任何并发症.结论:椎间盘造影结合椎间盘内亚甲蓝注射治疗椎间盘源性腰痛近期疗效比较理想,是一种安全有效的治疗方法.     

间盘源性下腰痛发生机制的探讨

目的：探讨间盘源性下腰痛的发生机制。方法：（1）辣根过氧化物酶（HRP）逆行追踪法：取成年Wistar大鼠随机分成3组（保留腰椎旁交感干组、切断腰椎旁交感干组及自身对照），每组7只。分别于L5-6椎间盘右后侧壁注入HRP，48h后取双侧L1、L2脊神经节制片，观察脊神经节内HRP标记细胞及切除腰椎旁交感干对HRP标记细胞数的影响。（2）荧光素逆行双标法和免疫组化方法：取成年Wistar大鼠7只，荧光素快蓝（FB）注入右侧第二腰神经后支，荧光素核黄（NY）注入L，．。间盘右后侧壁，观察右侧L2脊神经节内荧光素双标细胞；在有荧光素双标细胞的切片上进行免疫组化检查。结果：（1）各组大鼠双侧L1、L2脊神经节中均发现HRP标记细胞，当切断腰椎旁交感干后，脊神经节内HRP标记细胞数明显减少；（2）在右侧L2脊神经节内发现荧光素双标细胞；部分荧光素双标细胞含有降钙素基因相关肽（CGRP）。结论：间盘源性下腰痛可能是一种由腰椎间盘病变引起的，经交感神经传递的，主要累及L1、L2腰神经后支节段性支配区域（下腰区）的牵涉性疼痛。腰椎旁交感干内的交感神经纤维对疼痛的传导是间盘源性下腰痛发生的重要环节。     

高原汽车驾驶员腰痛分析

目的：本文对高原汽车驾驶员腰痛的状况,腰痛的性质、特征和诱因进行分析研究。方法：通过对1132名高原汽车驾驶员的问卷调查和91名驾驶员的体格检查,分析各种造成腰痛的原因和相关因素。结果：（1）高原缺氧反应可导致驾驶员发生腰痛,并具有一定的相关性。（2）职业行为和不良工作体位与腰痛有关。（3）腰痛性质以酸痛为主。（4）半数以上驾驶员腰背部有压痛点,而与腰背肌有关的压痛点占45.61%。结论：高原汽车驾驶员腰痛的病因较为复杂。此种腰痛为一种可逆性、与职业习惯相关的亚临床症候群。     

椎间盘造影术在椎间盘源性腰腿痛诊断中的应用

目的:探讨椎间盘造影术在椎间盘源性腰腿痛诊断中的应用.方法:选择80例临床怀疑椎间盘源性腰腿痛患者进行腰椎间盘造影,进行确诊.结果:80例接受间盘造影术的患者,69例证实为间盘源性疼痛,其余11例患者经进一步检查明确诊断,根据诊断选择恰当的方法进行治疗,取得满意疗效.结论:间盘造影在椎间盘源性腰腿痛诊断有重要作用,临床难以确诊病例应及时行腰椎间盘造影术.     

腰2神经节阻滞治疗慢性腰痛的疗效观察

目的:观察腰2(L2)神经节阻滞治疗慢性腰痛的疗效.方法2009年6月至2010年6月,我们对155例慢性腰痛或伴腿痛的患者用罗哌卡因+得宝松进行L2神经节阻滞,比较术后0h、1d、7d、1m、3m、6m视觉模拟评分量表(VAS)得分与术前VAS评分变化,以VAS评分减少50%或以上判定为治疗有效.结果术后0h、1d、7d、1m、3m、6m各有155例、150例、102例、78例、40例、27例患者VAS评分减少50%或以上.患者无阻滞相关的并发症.结论:L2神经节阻滞治治疗慢性腰痛在短期内有效,对于部分患者,可能推迟或避免手术治疗.     

冷冻治疗腰脊神经后支源性下腰痛的对照研究

目的：比较神经定位冷冻、无水酒精毁损、常规神经阻滞治疗腰脊神经后支源性下腰痛的近期、远期疗效。方法：60例非特异性腰痛患者随机分为三组：应用神经定位法分别予以神经冷冻、无水酒精毁损和常规神经阻滞治疗，每组20例。结果：三组治疗后近期疗效(治疗后1月)无差异，冷冻组和无水酒精组中、远期疗效(治疗后3月、6月)优于神经阻滞组，且冷冻组优于无水酒精毁损组。结论：神经定位冷冻治疗腰脊神经后支源性下腰痛可达长期止痛的效果。     

氙光低周波加封闭治疗腰腿痛的临床观察

我们对门诊就诊５２例腰腿痛病人，男３０人，女２２人，随机分为三组进行了对比观察。患者分组１（超短波组）、组２（Ｘｅｎｏｎ氙光低周波治疗组）和组３（氙光低周波加椎旁或硬膜外腔封闭组）。对于上述各组以ＶｉｓｕａｌＡｎａｌｏｇＳｃａｌｅ（ＶＡＳ）测痛法以疼痛为主要指标、快适度以舒适轻松程度为主要指标，就治疗前后自觉症状的改变进行了评价及统计学处理。结果表明：组３优于组２，组２优于组１，都具有显著性差异。本组结果提示日本医广公司生产的５５０／型氙光低周波治疗仪加激素类药物行椎旁或硬膜外腔封闭具有良好的协同作用，治疗效果显著。使ＶＡＳ痛苦度明显降低，同时治疗后还具有良好的舒适感，是治疗腰腿痛的好方法。     

腰椎稳定性训练治疗慢性非特异性腰痛的研究

目的:研究腰椎稳定性训练对慢性非特异性腰痛患者的治疗效果.方法:91名慢性非特异性腰痛患者随机分为治疗组(46人)和对照组(45人).两组患者均接受6周共18次治疗,治疗组患者进行腰椎稳定性训练,对照组患者接受磁热治疗.在患者治疗前、治疗6周后以及随访1年后分别评价其疼痛和功能障碍程度.结果:治疗6周后,治疗组较对照组患者在疼痛和功能障碍方面具有更显著的改善(P<0.05),治疗组疗效在随访1年后仍然得到维持(P<0.05).结论:腰椎稳定性训练是一种有效减轻慢性非特异性腰痛患者疼痛程度并改善其功能障碍的疗法.     

针刺对腰痛症患者皮肤血流量的影响

为了进一步明确会刺对痛症患者刺针局部及远隔部位的血流量的影响，本文以腰痛症患者为对象，用无损伤的计测方法（激光多普勒血流计、红外线热像仪）对针刺前后的皮肤血流量进行了直接与间接的观察。结果发现，针刺后，远离针刺部位的皮肤血流量的变化，没有一定的倾向；皮肤血流量的增加及皮肤温度的升高只是在行针之后刺针局部得到了确认。这种由针刺引起的局部限性皮肤血流量增加的机理，主要考虑为痛纤维轴索反射的作用。     

CLINICAL PROGNOSTIC FACTORS FOR PATIENTS WITH ANTERIOR KNEE PAIN IN PHYSICAL THERAPY; A SYSTEMATIC REVIEW

Background

Although many authors have studied the prognostic factors that may contribute to anterior knee pain, synthesis of the existing evidence has not been performed.

Purpose

The purpose of this systematic review is to summarize and examine existing prognostic models in patients with anterior knee pain that first present to physical therapists (primary care setting).

Design

Systematic review

Method

For this review Pubmed, Embase and Cinahl databases were searched and published papers that reported prognostic models for patients with anterior knee pain that first present to physical therapists (primary care setting) were selected. The authors extracted and summarized the univariate and multivariate predictors and evaluated which predictors consistently appeared to be relevant to pain, function, or recovery.

Results

Nine studies were included. The quality scores of these studies ranged from 9 to 17 positive items out of 21 items included in the assessment for quality. None of the prognostic models were validated internally or externally. Four studies were considered to be of sufficient quality. The authors of these four studies found 14 different predictors significantly related to pain intensity of which seven with limited evidence. Fifteen different predictors were found that were related to function of which seven with limited evidence. Furthermore, strong evidence was found that baseline pain intensity, pain coping and kinesiophobia are of no predictive value for pain, and activity related pain, pain coping and kinesiophobia are of no predictive value for function at follow up.

Conclusions

Because of the low quality of a number of studies and the heterogeneity of the examined variables and outcome measures of most of the studies, only limited evidence for seven predictors related to pain and seven predictors related to function in patients with anterior knee pain in a primary care setting was found.

Level of Evidence

1b     

LOW BACK PAIN IN A COMPETITIVE CRICKET ATHLETE

Physical therapists treating adolescent and young adult athletes with low back pain complaints should have a high level of clinical suspicion of the possibility for spondylolysis, spondylolisthesis, or developing stress reactions of the pars interarticularis. This case outlines the use of conventional radiography, computerized tomography, and Single photon emission computed tomography (SPECT) in the differential diagnosis for an adolescent cricket athlete with low back pain.     

THE INCIDENCE OF LOW BACK PAIN IN NCAA DIVISION III FEMALE FIELD HOCKEY PLAYERS

Purpose/Background:

The authors speculated that there may be an increased incidence of low back pain (LBP) in NCAA Division III female field hockey (FH) players. FH players may experience LBP for a variety of reasons including trauma from collisions or falls. Excluding these types of direct trauma, FH players may experience LBP due to excessive stress to spinal structures related to the forward flexed posture that predominates in field hockey. The authors speculated that because of the postural stresses inherent to field hockey there may be an increased incidence of LBP in this population. Therefore, the purpose of this study was to survey NCAA Division III female FH players and an age matched control group to determine if field hockey participation results in an increased incidence of LBP. The anticipated finding of an increased incidence of LBP would provide a rationale for the development of prophylactic interventions for this population.

Methods:

Subjects: Female NCAA Division III FH players (n=90) ranging in age from 18–24 years old who participated in the 2008 season were surveyed in regards to the incidence of LBP. A female age-matched control group from Misericordia University (n=98) without a history of field hockey participation was also surveyed. Both groups of subjects completed a voluntary pen and paper survey on the incidence of LBP not related to menstruation. Questions included but were not limited to; whether a significant episode of LBP had been experienced, the mechanism or injury, the duration and nature/location of symptoms. Responses from both groups were anonymous and confidential.

Results:

There was no difference in the incidence of LBP between the female FH players and the control group (p=0.951). The incidence of LBP was 56% (50/90) in the female FH players and 55% (54/98) in the controls. There was no difference in pain characteristics including pain referral patterns between the 2 groups. However, survey responses revealed a similar mean age of onset of LBP for both groups (16.23 +/- 1.80 years of age for FH players and 16.45 +/- 2.12 years of age for controls).

Conclusions:

The data did not support the authors'' speculation of a higher incidence of LBP in NCAA Division III female FH players compared to female age-matched controls. This suggests postures associated with field hockey do not appear to significantly increase the incidence of LBP in this population. However, the data revealed that females from both surveyed groups experienced an onset of LBP at a mean age of sixteen.

Level of Evidence:

2b     

射频消融髓核成型术治疗盘源性腰痛疗效观察

目的:通过对盘源性腰痛患者射频消融髓核成型术治疗1年后随访资料的分析,评估该技术的临床治疗效果。方法:2002～2003年,我们对26例通过椎间盘造影复制腰痛试验诊断为盘源性腰痛、经过正规保守治疗3个月无效的患者,采用射频消融髓核成型术治疗,所有患者术后1年随访。通过患者手术后2天内与1年后症状改善率[(术前VAS评分术后VAS评分)/术前VAS评分×100%]和主观满意程度进行分析,评价射频消融髓核成型术对盘源性腰痛的治疗效果。结果:所有26例患者术后2天内症状改善率为65%,患者主观满意率达88.5%;术后1年症状改善率为44%,患者主观满意率达30.8%。术后2天内及术后1年随访患者症状改善率和主观满意率与术前相比存在显著差异(P<0.05)。结论:射频消融髓核成型术对盘源性腰痛的治疗术后短期内可以收到较好的治疗效果,但1年后治疗效果会明显降低。     

臭氧溶核术治疗椎间盘源性下腰痛的远期随访

目的:观察臭氧溶核术治疗椎间盘源性下腰痛的远期疗效,并对照研究经典椎间盘造影术和臭氧椎间盘造影术诊断椎间盘源性下腰痛的价值.方法:对207例需进行臭氧溶核术的椎间盘源性下腰痛患者行前瞻性研究,在术中对疑似病变椎间盘先后进行经典椎间盘造影和臭氧椎间盘造影,分别观察诱发疼痛反应及病理分型.随访术后1年、2年、3年患者的视觉模拟疼痛评分(VAS).对术前和术后的VAS进行加权处理并评价疗效,同时对两种椎间盘造影术诱发疼痛试验阳性率进行对照,用SPSS 10.0统计软件进行统计学处理.结果:实际随访到病例181例,占入组随访病例的87.4%.术后随访1年、2年、3年的总有效率分别为88%、72%、78%,优良率为67%、63%、57%.在治疗有效者的243个间盘和治疗无效的62个间盘中臭氧诱发痛发生率分别为89.7%和45.2%,比较有明显差异.臭氧椎间盘造影诱发疼痛试验阳性率比经典椎间盘造影明显升高(57%:25%).结论:臭氧溶核术治疗椎间盘源性下腰痛的远期疗效稳定,术中臭氧诱发痛与疗效呈正相关,且诱发疼痛试验阳性率明显高于经典椎间盘造影术.     

脊神经射频脉冲调节术治疗腰椎源性疼痛疗效的系统评价

目的:根据目前临床研究证据系统评价脊神经脉冲射频调节治疗腰椎源性疼痛的疗效及安全性。方法:计算机检索Cochrane图书馆、Pub Med、中国期刊全文数据库(CNKI)、万方等数据库,并辅以手工检索相关文献,收集相关临床随机对照研究。按照Cochrane系统评价方法评价纳入研究的质量,提取有效的数据用Rev Man 5.2软件及stata 12.0进行统计分析。结果:共纳入12项研究,1063例患者。Meta分析结果显示,脉冲射频治疗腰椎源性疼痛疗效明显优于普通镇痛组,治疗终点VAS评分差异有统计学意义;脉冲射频组与口服药物、神经阻滞治疗组治疗神经病理性疼痛在安全性方面相比有较显著优势。结论:脉冲射频治疗方法对于缓解腰椎源性疼痛具有较满意短期及长期疗效,且安全性较高。     

腰椎间盘源性腰痛与炎症介质关系的临床研究

目的：探讨腰椎间盘源性腰痛程度与病变髓核及脑脊液中多种介质含量的关系.方法：腰椎间盘源性腰痛行髓核摘除手术患者,31例术前检测脑脊液中P物质和降钙素基因相关肽含量;20例术中取出髓核组织测定磷脂酶A2活性.结果：所有手术患者脑脊液中神经肽类介质（P物质、降钙素基因相关肽）含量高于正常对照组,并与疼痛程度相关.病变椎间盘髓核中磷脂酶A2活性水平明显高于自体血和健康人,其疼痛程度与磷脂酶A2活性水平显著相关.结论：椎间盘源性腰痛患者脑脊液中神经肽类介质含量较正常人高,椎间盘髓核中炎症介质与椎间盘源性腰痛的程度有关.     

骨痹汤治疗原发性骨质疏松症腰背痛疗效观察

目的:评价骨痹汤治疗原发性骨质疏松症腰背痛的临床疗效.方法:2009年1月至2010年8月,对80例原发性骨质疏松症引起的腰背痛用骨痹汤治疗.结果:80例患者中,显效24例(30％);好转48例(60％);无效8例(l0％),总有效率为90％.起效时间最短为7天,最长15天.服药时间最短为30天,最长90天.随访时间最短为3月,最长18月.结论:骨痹汤可以明显缓解原发性骨质疏松症引起的的腰背痛、全身骨痛、乏力等临床症状.