腰背痛的评估

腰背痛是50岁以下人群失能的主要原因。该病在成年人中的年发病率为1 0%-15%，发达国家的时点患病率约为 30% 左右。腰痛 (Low-back pain, LBP) 是每年仅次于上呼吸道疾病的第二常见就诊原因，终身患病率为 70%-85%。尽管其患病率高，但是大多数急性腰痛患者的总体预后较好，约有 90% 的患者恢复后无后遗症。[1]Spitzer WO, LeBlanc FE, Dupuis M, et al. Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine. 1987;12(suppl):S1-S59.http://www.ncbi.nlm.nih.gov/pubmed/2961086?tool=bestpractice.com 症状复发很常见，但大多数复发不会导致残疾。有更小一部分人群会因慢性腰痛的症状持续超过 6 个月而丧失行为能力。抑郁、工作不满、涉及经济补偿的医疗法律相关的问题都是患者需要长期承受的问题。[2]Bigos SJ, Battie MC, Spengler DM, et al. A prospective study of work perceptions and psychosocial factors affecting the report of back injury. Spine. 1991;16:1-6.http://www.ncbi.nlm.nih.gov/pubmed/1825891?tool=bestpractice.com[3]Burton AK, Tillotson KM, Main CJ, et al. Psychosocial predictors of outcome in acute and subacute low back trouble. Spine. 1995;20:722-728.http://www.ncbi.nlm.nih.gov/pubmed/7604349?tool=bestpractice.com[4]Carragee EJ, Alamin TF, Miller JL, et al. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J. 2005;5:24-35.http://www.ncbi.nlm.nih.gov/pubmed/15653082?tool=bestpractice.com[5]Boos N, Semmer N, Elfering A, et al. Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging: predictors of low back pain-related medical consultation and work incapacity. Spine. 2000;25:1484-1492.http://www.ncbi.nlm.nih.gov/pubmed/10851096?tool=bestpractice.com 一些研究证实患者脱离工作的时间越长，其返回工作岗位的可能性越低。[6]Bergquist-Ullman M, Larsson U. Acute low back pain in industry. A controlled prospective study with special reference to therapy and confounding factors. Acta Orthop Scand. 1977;170:1-117.http://www.ncbi.nlm.nih.gov/pubmed/146394?tool=bestpractice.com 此外，还有少部分患者会进展为致残性的下腰部疼痛，他们会对社会造成巨大的经济负担。在美国，每年由此导致的经济损失约为 500 亿美元。[7]Cypress BK. Characteristics of physician visits for back symptoms: a national perspective. Am J Public Health. 1983;73:389-395.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1650784/pdf/amjph00639-0037.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/6219588?tool=bestpractice.com[8]Coste J, Delecoeuillerie G, Cohen de Lara A, et al. Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice. BMJ. 1994;308:577-580.http://www.bmj.com/cgi/content/full/308/6928/577http://www.ncbi.nlm.nih.gov/pubmed/8148683?tool=bestpractice.com[9]Waddell G. Low back pain: a twentieth century health care enigma. Spine. 1996;21:2820-2825.http://www.ncbi.nlm.nih.gov/pubmed/9112705?tool=bestpractice.com[10]Pauza KJ, Howell S, Dreyfuss P, et al. A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J. 2004;4:27-35.http://www.ncbi.nlm.nih.gov/pubmed/14749191?tool=bestpractice.com 一项综述研究发现，适应不良的疼痛应对行为、非器质性病变、功能受损、健康状态、存在精神疾病都会增加致残性腰痛的风险。医生在询问和治疗患者的时候要考虑这些危险因素。[11]Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA. 2010;303:1295-1302.http://www.ncbi.nlm.nih.gov/pubmed/20371789?tool=bestpractice.com