妊娠期腰背痛护理

腰背痛是孕妇妊娠期的首位常见症状,是影响其妊娠期生活质量的主要因素。医务人员对妊娠期腰背痛应给予足够的重视,积极开展相关健康教育,教会孕妇预防腰背痛发生、缓解腰背痛的方法等,使孕妇掌握相关知识,做到自我保健,减轻妊娠期不适,提高生活质量。     

Exercise for the Primary, Secondary and Tertiary Prevention of Low Back Pain in the Workplace: A Systematic Review

Introduction Low back pain (LBP) is one of the most costly conditions to manage in occupational health. Individuals with chronic or recurring LBP experience difficulties returning to work due to disability. Given the personal and financial cost of LBP, there is a need for effective interventions aimed at preventing LBP in the workplace. The aim of this systematic review was to examine the effectiveness of exercises in decreasing LBP incidence, LBP intensity and the impact of LBP and disability. Methods A comprehensive literature search of controlled trials published between 1978 and 2007 was conducted and a total of 15 studies were subsequently reviewed and analyzed. Results There was strong evidence that exercise was effective in reducing the severity and activity interference from LBP. However, due to the poor methodological quality of studies and conflicting results, there was only limited evidence supporting the use of exercise to prevent LBP episodes in the workplace. Other methodological limitations such as differing combinations of exercise, study populations, participant presentation, workloads and outcome measures; levels of exercise adherence and a lack of reporting on effect sizes, adverse effects, and types of sub-groups, make it difficult to draw definitive conclusions on the efficacy of workplace exercise in preventing LBP. Conclusions Only two out of the 15 studies reviewed were high in methodological quality and showed significant reductions in LBP intensity with exercise. Future research is needed to clarify which exercises are effective and the dose-response relationships regarding exercise and outcomes.     

原发性椎管内肿瘤与腰背痛（附73例临床分析）

73例原发性椎管内肿瘤回顾性研究表明，早期症状不典型，易误诊为其它原因引起的颈、肩、腰、背及坐骨神经痛。MRI检查，非离子碘水溶性造影剂脊髓造影为诊断椎管内肿瘤的重要手段。根据临床症状体征特点，针对性选择影像学检查方法，才能早期诊断治疗椎管内肿瘤。     

Psychological factors in the failed back

Pain is a complex phenomenon. Lack of understanding of its nature leads to two common mistakes in the failed back, firstly to look for a discrete physical cause and secondly to ascribe pain to psychological causes. This paper explores the nature of pain in the failed back and discusses the implications for treatment.     

The Rotated Segment in Acute Low Back Pain

Abstract

A clinically relevant asymmetric rotation may be detected in acute low back pain patients who present with a lateral lumbar shift. It is suggested, that an examination category of asymmetric rotation could be used to guide treatment choices in the management of acute low back pain. Because of rotational coupling in the lumbar spine both rotation and sideflexion movements are considered relevant to the examination and treatment of asymmetric rotation. In this paper, five different tests are described that can be used for detecting the presence and direction of a clinically relevant asymmetric rotation. Further to this, it is recommended that a cluster of tests, rather than a single test is used in this clinical decision making process. Treatment for asymmetric rotation may include the use of rotation, sideflexion and sidegliding techniques. Rotational techniques are emphasized. Research is needed in which the theoretical basis for the selection of treatment for patients presenting with a clinically relevant asymmetric rotation is described and critically analyzed.     

A doubie-blind,between-patient comparison of alclofenac (‘Prinalgin’) and indomethacin in the treatment of low back pain and sciatica

Summary

A double-blind, between-patient comparison of alclofenac and indomethacin was carried out in 60 patients with low back pain and sciatica. Pain, functional disability and signs of dural irritation (Laségue's sign) were rated by the clinician before and at the end of each 7-day treatment period, and an overall assessment of treatment effectiveness was made by both clinician and patients.

Response to treatment in terms of patient improvement was considered satisfactory with both drugs, but more erratic in those patients with an acute condition. Analysis of pain scores showed a significant tendency for patients with acute or chronic low back pain to improve more with alclofenac than with indomethacin treatment. Overall assessments by the clinician and patients also indicated signiJcantly greater improvement with alclofenac.     

High frequency of McKenzie��s postural syndrome in young population of non-care seeking individuals

Objectives

The role of postural loads as a risk factor for back pain and musculoskeletal symptoms is unclear. McKenzie proposed in his classification of mechanical syndromes a postural syndrome, in which people only develop symptoms from sustained loading, which is relieved by a change in position and has no effect on movement or function. Because of the low level disability with postural syndrome, it was suggested that few seek healthcare for this problem.

Methods

This study used a two-stage process first to give a questionnaire to 100 students and staff from a university to determine who appeared to have postural syndrome, and then applied a physical examination to those who consented.

Results

One hundred and thirty-eight were approached, of who 100 completed questionnaires and 66% appeared to have postural syndrome. Of the 66 who appeared to have postural syndrome, 37 consented to have a physical examination. Of the 37, 31 met the criteria for postural syndrome, with postural syndrome being significantly associated with pain on sustained loading and pain abolition on posture correction. Most postural syndrome was in the lumbar spine and associated with sitting, but other sites and causes were also noted.

Discussion

This study lends credibility to McKenzie’s postural syndrome, but also suggests this as a possible precursor for future more disabling or painful problems. Postural syndrome may not feature in those seeking professional healthcare, but is clearly highly prevalent in a young population.