腰背痛的治疗

提纲
腰背痛的发病情况
腰背痛病因和潜在机制
腰背痛的临床评估与治疗决策 腰背痛的手术治疗及效果 阿片类药治疗腰背痛的应用
概念
正确理解腰痛机制,先明确文献中出现的几个概念
Non-specific low back pain （非特异性腰痛）is pain in the low back which cannot be attributed to a specific cause. About 90% of all patients with low back pain will have non-specific low back pain, which, in essence, is a diagnosis based on exclusion of specific pathology.
Mechanical low back pain (机械性腰痛) is defined as pain that appears to have been caused by a normal mechanical event (eg. Lifting, twisting, etc), and is aggravated by movement.
腰背痛的常见影像学异常
影像学检查发现，腰背痛患者常有骨质增生、脊椎前移和椎间盘退 化的异常表现。
腰椎滑脱和椎间盘退化最常发生在L4/L5和L5/S1。
腰背痛患者转诊接受X线检查的横断面描述性分析研究。 Igbinedion BO, Akhigbe A. Correlations of Radiographic Findings in Patients with Low Back Pain. Niger Med J. 2011 Jan;52(1):28-34.
腰痛分类及范围
Non-organic LBP
LBP Non-specific LBP
Mechanical LBP
specific LBP
Non-Mechanical Visceral
LBP
diseases
腰痛病因及分类
Mechanical LBP
Non-Mechanical LBP
Visceral Diseases Non-organic LBP
Non-Mechanical low back pain (非机械性腰痛) is defined as pain that appears to have been mainly caused by a non mechanical event. NMBP is aggravated by rest or sleep, often waking the person in the second half of the night.
影像学与腰痛关系
MRI in asymptomatic individuals
Herniated disks 9-76% Bulging disks 20-81% Degenerative disks 46-93% Annular tears 14-56%
Disc degeneration: Approximately 80%-100% of people without back pain have this, so finding may not be related to patient’s pain.
慢性腰痛
提纲
腰背痛的发病情况
腰背痛病因和潜在机制 腰背痛的临床评估与治疗决策 腰背痛的手术治疗及效果 阿片类药治疗腰背痛的应用
概念
Low back pain =腰痛≠下腰痛 Back：The posterior potion of the trunk of
the human body between the neck and the pelvis(美国传统词典)
国人误解了英文的意思
概念
Neck pain (颈项痛)
Thoracic back pain (胸背痛)
back pain Thoracolumbar back pain
(背痛)
Biblioteka Baidu
(胸腰背痛)
Low (lumbar) back pain (腰痛)
Lumbosacral back Pain (腰骶痛)
Sacrococcygeal Pain (骶尾痛)
Non-specific low back pain （特异性腰痛）is defined as symptoms caused by a specific pathophysiological mechanism, such as infection, osteoporosis, rheumatoid arthritis, fracture, or tumour, etc.
影像学与腰痛关系
Several studies have shown that there is no correlation between MRI findings and patients’ low back symptoms.
1. Wittenberg et al., 1998 2. Smith et al., 1998 3. Savage et al., 1997 4. Alyas et al., 2007
Sacral back pain (骶部痛)
Coccyx pain (Coccydynia) (尾骨痛)
流行病学
60%–90% lifetime prevalence About 85-90% of LBP sufferers
will get better in 3 days to 6 weeks Of the remaining 10-15%, most will never get completely well 1% of population are disabled because of LBP. Highest prevalence among 4060 year of age. Male to female ratio is almost 1:1