海训青年战士下腰痛的流行病学调查研究

目的对海训青年战士下腰痛的流行病学进行调查。方法通过发放腰痛调查表和实地考察的方式,对2002年6月—2005年9月参加海训的3 200名现役士兵进行腰痛发病状况调查。结果海训条件下战士下腰痛的患病率为55.90%,明显腰痛的患病率为31.80%;长期海水浸泡可诱发战士下腰痛(检出率为73.02%)。结论通过调查发现海训青年战士下腰痛与特殊训练环境、心理、组织管理和个体等因素有关。     

海军潜艇某部艇员下腰痛的脊柱功能调查与分析

目的了解潜艇艇员下腰痛的患病及其脊柱功能状况,并分析相关影响因素。方法通过问卷调查海军某潜艇基地现役艇员的一般情况、职业、生活习惯和下腰痛等情况。按照纳入标准确定143例下腰痛艇员,入选者采用疼痛视觉模拟评分法、专项体格检查及改良Oswestry功能障碍指数进行评估。结果所选取的423例艇员中下腰痛143例,占33.81%,腰部疼痛视觉模拟评分法评分以服役年限≥9年组（8.52±0.68）最高,与其他服役年限组比较差异有统计学意义（P<0.05）。下腰痛艇员Oswestry功能障碍指数总分（37.92±3.22）分,其影响因素与从事专业、服役年限、病程时间、外伤史有关。结论现役艇员中下腰痛发病率较高,脊柱功能状况差,不适症状明显,应积极开展健康教育,提高艇员对疾病的认知能力,建立健康生活习惯。     

硬膜外麻醉术后下腰痛与性别的关系研究

目的：探讨硬膜外麻醉术后下腰痛与性别的关系。方法：采用自行设计的调查问卷,对我院硬膜外麻醉165例术后第1～3天下腰痛的发生情况进行调查,并分析下腰痛与性别的关系。结果：女性患者硬膜外麻醉术后第1～3天,下腰痛的发生率及视觉模拟评分（VAS）分值均显著高于男性患者（P〈0．05）。结论：女性患者硬膜外麻醉术后下腰痛发生率显著高于男性患者。     

海军某部官兵下腰痛调查与分析

目的：调查分析海军某部官兵下腰痛患病情况。方法：选择海军某部官兵859例,通过发放自行设计的兵种职业病调查问卷表,并结合现场检查及诊断,调查官兵下腰痛总体患病情况及其疼痛原因、程度和频率等。结果：海军官兵罹患下腰痛602例,患病率70.1%。其中基地官兵326例,患病率为60.9%;潜艇官兵184例,患病率为93.4%;其他舰艇及驻岛官兵92例,患病率为28.4%。基地官兵下腰痛326例中,因久坐而腰局部酸痛者最多,其次为疲劳后疼痛;执行任务舰艇及驻岛部队官兵下腰痛276例中,因久坐而疼痛加重者占33.9%,因搬运重物而疼痛加重者占22.3%;每周疼痛1次者占40.0%,每天疼痛2或3次者占36.6%。结论：海军官兵下腰痛患病率较高,应有针对性地开展腰背肌训练等知识教育,提高官兵自我防护意识。     

Wallis动态稳定系统置入治疗单纯性腰椎间盘突出症的临床疗效分析

目的：探讨棘突间动态稳定系统（ Wallis）置入治疗单纯性腰椎间盘突出症的临床效果。方法2011年9月～2012年9月收治的腰椎间盘突出症患者10例,10例LDH患者均行腰椎后路开窗髓核摘除术并植入Wallis棘突间动态稳定系统固定治疗,观察术前、术后情况并进行VAS评分、下腰痛JOA评分及Oswestry功能障碍指数变化。结果10例患者均获得随访,随访时间3～13个月（平均9±2个月）。术后患者疼痛消失,症状与体征均有明显改善。治疗后视觉模拟VAS评分较术前明显降低（P＜0．01）,下腰痛JOA评分较术前显著增加（P＜0．01）,ODI评分较术前显著降低（P＜0．01）。结论提示棘突间动态稳定系统置入治疗单纯性腰椎间盘突出症的临床效果良好。     

内灸式激光针灸针治疗寒湿腰痛的疗效观察

目的观察内灸式激光针灸针治疗寒湿腰痛的临床疗效。方法寒湿腰痛患者68例,随机分为试验组和对照组,每组34例。试验组采用内灸式激光针灸针治疗;对照组采用传统针刺法治疗。治疗后应用疼痛视觉模拟量表（visual analogue scale,VAS）和Oswestry功能障碍指数（oswestry dability index,ODI）评估疗效。结果 （1）VAS评分：两组患者治疗后与治疗前比较,VAS评分均显著下降（P〈0.05）;第1次治疗后两组VAS评分分别为：试验组（3.95±1.89）分;对照组（4.94±2.05）分,两组比较差异有显著意义（P〈0.05）。治疗10次后两组的VAS评分分别为：试验组（3.50±1.18）,对照组（3.69±1.27）分,两组比较差异无显著意义（P〉0.05）。（2）ODI评分：第1次治疗后两组患者ODI评分分别为：试验组（16.28±7.82）分,对照组（16.14±7.18）分,两组比较差异无显著意义（P〉0.05）。治疗10次后两组患者的Oswestry评分均显著下降,与治疗前比较差异有显著意义（P〈0.05）,组间比较差别无显著意义（P〉0.05）。结论内灸式激光针灸针法治疗寒湿腰痛即时止痛效果优于传统针刺疗法,但治疗1次对提/携物、坐、行走各项功能无明显改善;治疗1个疗程后两种疗法皆可止痛及改善各种功能。     

肌内效胶贴联合运动训练治疗慢性下腰痛的疗效

 目的 评价肌内效胶贴联合运动训练治疗慢性下腰痛的疗效。方法 某训练基地非特异性下腰痛患者113例, 按照就诊顺序分为肌内效胶贴组(A组, n=58)和肌内效胶贴联合训练组(B组, n=53), 于治疗1周后和4 周后分别应用视觉模拟评分(visual analogue scale, VAS)、Oswestry功能障碍指数(oswestry disability index, OSW)评价治疗效果。结果 B组治疗1和4 周后, VAS评分(5.05±1.98)分、OSW(64.73±7.92)分与治疗前相比明显改善, 差异有统计学意义(P<0.01)。A组治疗1周后, 疼痛症状和残疾指数较治疗前无明显改善, 治疗4周后明显好转。治疗后1周和4周B组的VAS 评分及OSW指数较A组明显下降, 差异有统计学意义(P<0.01)。结论 肌内效胶贴与运动训练联合应用能显著缓解慢性非特异性下腰痛的疼痛症状, 明显减轻残疾程度, 值得临床推广。
     

60-69岁老年人腰椎椎间隙高度与慢性腰痛的相关性研究

目的:分析老年人腰椎椎间隙高度与慢性腰痛的相关性。方法:应用整群抽样的方法在浙江省丽水市抽取60-69岁老年人群。通过现场调查收集资料,资料内容包括慢性腰痛的患病状况,同时对研究人群进行腰、骶部骨性结构X线摄片与测量。结果:老年人中,无慢性腰痛与患慢性腰痛人群腰椎的椎间隙高度测试值、椎间隙高度比值均无显著差异,而老年人中,慢性腰痛人群Oswestry功能障碍指数与其L2-L3节段前缘、L5-S1节段中缘的椎间隙高度、L5-S1椎间隙高度比值呈显著相关。结论:60-69岁老年人腰椎的椎间隙高度与慢性腰痛导致的功能障碍存在相关。     

CT引导下水针刀靶向微创治疗腰椎横突综合征临床研究

【摘要】 目的 探讨CT引导下水针刀靶向微创松解注射治疗腰椎横突综合征的疗效及安全性。方法 选取2017年1月至2019年4月就诊的腰椎横突综合征患者152例,随机分为观察组和对照组各76例。观察组采用CT引导下水针刀靶向微创松解注射治疗,对照组采用小针刀治疗。疗程结束3个月后采用总有效率来评定患者的治疗效果。采用Oswestry功能障碍指数（ODI）、JOA下腰痛评分、视觉模拟量表（VAS）评分对两组患者治疗前后的腰部功能障碍与疼痛程度进行评估,并比较治疗前后两组间差异。结果 治疗后观察组愈显率（治愈+显效）为76.4%,总有效率为94.4%,对照组愈显率为55.7%,总有效率为77.1%。与对照组相比,观察组的愈显率、总有效率更高（均P＜0.01）。治疗前两组患者ODI脊柱功能障碍总分、ODI、JOA下腰痛评分、VAS评分比较差异无统计学意义（均P＞0.05）。两组治疗后观察组ODI脊柱功能障碍总分、ODI、VAS评分与对照组比较下降更为显著（均P＜0.01）;JOA下腰痛评分与对照组比较提高更为显著（P＜0.01）。结论 采用CT引导下水针刀靶向微创松解注射技术治疗腰椎横突综合征疗效好,安全性高,患者痛苦小,对正常软组织的损伤少,是一种精准的微创介入治疗法。     

"益髓通督"针刺法治疗慢性非特异性 下腰痛临床效果观察

目的观察"益髓通督"针刺法治疗慢性非特异性下腰痛的临床效果。方法选取解放军967医院自2017年11月至2018年12月收治的56例慢性非特异性下腰痛患者为研究对象,将患者随机分入A组和B组,每组各28例。A组患者接受洛索洛芬钠片口服治疗,B组患者接受"益髓通督"针刺法治疗。共治疗2周。比较两组的治疗有效率,以及治疗前后的Oswestry功能障碍指数、疼痛视觉模拟评分。结果治疗后,A组治愈10例、好转12例、未愈6例,有效率为78.6%(22/28),B组治愈16例、好转11例、未愈1例,有效率为96.4%(27/28)。两组有效率比较,差异有统计学意义(P<0.05)。治疗2周后,A组、B组的Oswestry功能障碍指数分值分别为(39.6±16.2)分、(34.9±13.7)分,均低于本组治疗前,且B组低于A组,差异有统计学意义(P<0.05)。治疗2周后,A组、B组的疼痛视觉模拟评分分别为(5.24±2.43)分、(2.94±2.27)分,均低于本组治疗前,且B组低于A组,差异有统计学意义(P<0.05)。结论 "益髓通督"针刺法治疗慢性非特异性下腰痛临床效果良好,可明显缓解疼痛,改善活动功能。     

中度高原地区坦克乘员腰痛的现患调查

目的：了解中度高原地区坦克乘员腰痛的发病情况、流行病学特点。方法：采用问卷调查、实地考察、物理检查、统计分析等方法，对中度高原地区1041名坦克乘员腰痛情况进行横断面调查。结果：1041名坦克乘员中腰痛患病率45．9％，各工种驾驶员检出率最高（P〈0．05）。腰痛随兵龄增加而明显升高，5年以上驾驶员患病率高达87．5％。经多元回归分析，吸烟、反复高举重物、训练中反复弯腰3种因素与腰痛相关。结论：中度高原地区坦克驾驶员腰痛患病率高，发病率随从业时间而增大。     

运动疗法对部队下腰痛病例的干预效果评价

目的 评价徒手核心肌力训练和悬吊运动疗法对下腰痛病例的干预效果.方法 以空军某场站部分下腰痛官兵为研究对象,采用抽签方式将144例下腰痛患者随机分成3组,第1组为徒手核心肌力组(徒手核心肌力训练+普通物理治疗),第2组为悬吊运动疗法组(悬吊运动疗法+普通物理治疗),第3组为对照组(普通物理治疗组),每组48例,开展6周干预试验.干预前、干预2周、4周、6周后分别对3组病例发放调查问卷,了解腰痛程度(VAS评分)、腰椎功能状况(Roland评分)及活动度(FFD评分),同步测量并观察3组病例的腰部肌力变化. 结果 全程参与的3组人数分别是:徒手核心肌力组43例,悬吊运动疗法组43例,对照组44例;徒手核心肌力组VAS评分为3.25、Roland评分为5.83、FFD评分为8.58;悬吊运动疗法组VAS评分为3.30、Roland评分为5.93、FFD评分为8.10;对照组VAS评分为2.41、Roland评分为3.03、FFD评分为7.40.3组下腰痛干预有效率分别为90.90%、85.13%和46.82%.试验组组间各项指标均无显著性差异(P>0.05),与对照组比较有显著性差异(P<0.05). 结论 徒手核心肌力训练和悬吊运动疗法对下腰痛病例均有明显疗效.在不同环境下,部队卫生机构可根据相应的设施条件对下腰痛病例选用徒手核心肌力训练或悬吊运动疗法进行干预,从而有效缓解下腰痛.     

Trunk muscle strength and disability level of low back pain in collegiate wrestlers

INTRODUCTION/PURPOSE: Low back pain (LBP) is a frequent injury in athletes. This study examined the relationship between isokinetic trunk muscle strength and the functional disability level of chronic LBP. We particularly focused on the existence of radiological abnormalities (RA) in the lumbar region. METHODS: Subjects were 53 collegiate wrestlers. Trunk extensor and flexor muscle strength was measured at three angular velocities (60, 90, and 120degrees x s(-1)). The examined parameters for trunk muscle strength were peak torque, work, average torque, and average power. The disability level of LBP was estimated by using two questionnaires. Based on the RA evaluation with x-ray and MRI, all 53 wrestlers were assigned to two groups as the RA group (N = 35, 66%) and the non-RA group (N = 18, 34%). Correlations between trunk muscle strength and the disability level of LBP in each group were analyzed with Spearman's rank test. RESULTS: Without considering the disability level, there were 14 subjects with LBP (40%) in the RA group and 8 (44%) in the non-RA. Significantly correlated parameters with the disability level of LBP could be observed only when the subjects were restricted to the non-RA group. The correlated parameters with the two questionnaires were peak torque at 120degrees x s(-1), work at 60degrees x s(-1) and 90degrees x s(-1), and average torque at 90degrees x s(-1) and 120degrees x s(-1). There were no significantly correlated parameters in the RA group. None of the trunk flexor parameters were significantly correlated with the disability level of LBP. CONCLUSION: The relatively low strength of trunk extensors may be one of the factors related to nonspecific chronic low back pain in collegiate wrestlers.     

The assessment of intersegmental motion and pelvic tilt in elite oarsmen

Low back pain (LBP) is a common problem in elite oarsmen. The relevance of spinal and pelvic flexibility to good rowing technique and the incidence of LBP is unclear. PURPOSE: The aim of this study was to investigate patterns of spinal and pelvic mobility in a group of elite oarsmen with and without a history of LBP. METHODS: Twenty elite oarsmen were recruited into this study, including nine with no history of spinal problems, four with a current spinal problem, and the remainder with a history of LBP. Subjects were scanned using an interventional magnetic resonance imaging (MRI) scanner. Four key stages of the rowing stroke were simulated within the scanner, and sagittal images of the lumbar spine and sacrum were obtained. From these images intersegmental motion was determined along with the angle of lordosis and position of the lumbar spine and sacrum. RESULTS: Different mobility trends were seen; oarsmen with no history of LBP demonstrated the greatest mobility in their lower lumbar regions (at the L5/S1 level in the catch position 7.5 degrees +/-1.3 in normals; 4.8 degrees +/-1.2 in previous LBP groups; and 2.8 degrees +/-5.5 in current LBP group) and the lowest rotation of their pelvis (level in the catch position 13.9 degrees +/-11.2 in normals; 16.1 degrees +/-6.8 in previous back pain groups; and 15.2 degrees +/-11.2 in current back pain group). In contrast, those with either current or previous LBP presented with a hypomobility of their spine which appeared to be compensated for by increased pelvic rotation. CONCLUSIONS: Marked differences were observed in the motion characteristics of these 3 groups of oarsmen. At present it is not known if these changes are causative or effect.     

快速反应部队士兵焦虑及相关因素的调查分析

目的：探讨快速反应部队士兵焦虑症状的发生、分布情况及可能的影响因素。方法：采用焦虑自评量表进行抽样问卷调查,统计分析调查结果和相关因素。结果：①士兵焦虑总体发生率为12.9%;②影响焦虑发生的主要因素有：入伍时间、服役兵种、躯体性疾病和连队业余文化生活,与士兵的文化程度关系不明显。结论：快速反应部队士兵的焦虑发生率较普通人群高,主要与部队的生活工作性质有关。     

MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain

Objective:

To investigate the changes in paraspinal muscle cross-sectional area (CSA) and composition, using the digital data from lumbar spine MRIs of patients with acute and chronic low back pain (LBP).

Methods:

In total, 178 patients with unilateral LBP who had lumbar MRI examination were recruited. The data were obtained by a retrospective documentation audit. The CSAs and mean signal intensities of the bilateral paraspinal muscles [psoas major (PM), quadratus lumborum, multifidus (MF) and erector spinae (ES)] were measured, and the percentage of fat infiltration was calculated. The data between the painful side and non-painful side were compared, and between-group comparisons were tested. 42 patients with chronic unilateral LBP could indicate the problem level, and the CSA and mean signal intensity of the MF muscle were analysed at the problem level, and one vertebral above and one vertebral level below the problem level.

Results:

The CSAs of the PM and ES muscles were significantly decreased in the acute LBP group, while in the chronic LBP group, significant reduction in CSA was found in the MF and ES muscles on the painful side compared with the non-painful side. The mean signal intensity and fat content of the ES muscle on the painful side in the chronic LBP group was significantly higher than that on the painful side in the acute LBP group. The significant decrease of CSA in the MF muscle was found at multiple levels on the painful side.

Conclusion:

The present findings show that there is selective ipsilateral atrophy of paraspinal muscles, specific to the symptomatic side, in patients with acute and chronic LBP. The reduction of the muscle CSA and increased fatty infiltration occurred synchronously, and the extent of change is significantly greater in chronic LBP in the ES muscle. Atrophy of the MF muscle appears to be at multiple levels but side specific in relation to symptoms in patients with chronic LBP, and the decreased muscle CSA may occur prior to fatty infiltration.

Advances in knowledge:

There are specific paraspinal muscles undergoing atrophy and fatty infiltration in patients with acute and chronic LBP on the symptomatic side. The CSA of the MF muscle decreased at multiple levels on the symptomatic side in patients with chronic unilateral LBP, which may occur prior to fatty infiltration.     

Physical activities and low back pain: a community-based study

PURPOSE: Very little is known about the relationship between physical activity and low back pain (LBP) in general populations. This study aimed to evaluate the relationship between different dimensions of physical activity and LBP among all adults of a defined community. METHODS: A cross-sectional survey addressed all adults aged 22-70 of a single town. Inhabitants were asked to complete a self-administered questionnaire regarding physical activities, LBP, and related characteristics. The Beacke Physical Activity Questionnaire evaluated physical activity, and the Modified Roland and Morris Disability Questionnaire, a pain severity scale, and the Pain Symptoms Frequency and Bothersomeness Indices evaluated LBP. RESULTS: High occupational activity demands contributed to increased LBP prevalence, and, conversely, high sporting activity participation contributed to a decline in all LBP measures. Subjects free of LBP and subjects who participate in sporting activities are more likely not to smoke and not to participate in high occupational activity demands. Type of sporting activity was not associated with LBP prevalence or severity. CONCLUSIONS: Different dimensions of physical activity yield different relationships to LBP. There are several shared characteristics of those participating in sport on a regular basis and those free of LBP. Both groups present a healthier lifestyle. Although LBP was less frequent among those who participate in sporting activities, participating in sporting activities did not contribute independently to a lower prevalence of LBP. However, once LBP was established, participating in sporting activities contributed indirectly to its severity.     

Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports

ObjectiveTo examine whether passive hip rotation motion was different between people with and without low back pain (LBP) who regularly participate in sports that require repeated rotation of the trunk and hips. We hypothesized that people with LBP would have less total hip rotation motion and more asymmetry of motion between sides than people without LBP.DesignTwo group, case control.SettingUniversity-based musculoskeletal analysis laboratory.ParticipantsForty-eight subjects (35 males, 13 females; mean age: 26.56±7.44 years) who reported regular participation in a rotation-related sport participated. Two groups were compared; people with LBP (N=24) and people without LBP (N=24; NoLBP).Main outcome measures: Data were collected on participant-related, LBP-related, sport-related, and activity-related variables. Measures of passive hip rotation range of motion were obtained. The differences between the LBP and NoLBP groups were examined.ResultsPeople with and without a history of LBP were the same with regard to all participant-related, sport-related and activity-related variables. The LBP group had significantly less total rotation (P=.035) and more asymmetry of total rotation, right hip versus left hip (P=.022) than the NoLBP group. Left total hip rotation was more limited than right total hip rotation in the LBP group (P=.004). There were no significant differences in left and right total hip rotation for the NoLBP group (P=.323).ConclusionsAmong people who participate in rotation-related sports, those with LBP had less overall passive hip rotation motion and more asymmetry of rotation between sides than people without LBP. These findings suggest that the specific directional demands imposed on the hip and trunk during regularly performed activities may be an important consideration in deciding which impairments may be most relevant to test and to consider in prevention and intervention strategies.     

Physical therapy and changes in disability for patients with low back pain

OBJECTIVE: The purpose of this study was to describe the changes in disability for patients being treated for low back pain (LBP) at a military physical therapy clinic from the time of initial evaluation to discharge from physical therapy and to compare those changes across categories of symptom duration and location. METHODS: Three hundred four consecutive patients who completed a course of physical therapy for LBP were evaluated with the Oswestry LBP Disability questionnaire at the time of initial evaluation and discharge from physical therapy. RESULTS: In all of the patient groups, mean Oswestry scores had decreased significantly from the time of initial evaluation to discharge from physical therapy, indicating that patients experienced significantly decreased levels of disability at the time of discharge from physical therapy. However, patients with LBP without lower extremity symptoms generally had greater decreases in disability than patients with LBP with lower extremity symptoms. Furthermore, whereas patients in the acute groups had the greatest decrease in disability, patients in the chronic groups had the smallest decrease in disability. CONCLUSION: Clinicians should use LBP symptom duration, as well as the presence or absence of lower extremity symptoms, to assist in developing treatment prognoses for patients with LBP.