脑力劳动者与体力劳动者慢性非特异性腰痛的临床和影像特点比较
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摘要
目的:比较脑力劳动者与体力劳动者慢性非特异性腰痛的临床和影像特点。方法:回顾性分析39例慢性非特异性腰痛患者的病例资料,其中脑力劳动者18例(脑力劳动组)、体力劳动者21例(体力劳动组)。男11例,女28例。年龄31～60岁,中位数48岁。比较2组患者治疗前的腰痛视觉模拟量表(visual analogue scale,VAS)评分、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分以及口服美洛昔康片2周后的临床疗效,观察腰椎骨赘情况,测量并比较2组患者的脊柱全长X线片上骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、胸腰联合角(thoracolumbar junction,TLJ)、T_1脊柱骨盆倾斜角(T_1-spinopelvic inclination,T_1-SPi)、T_9脊柱骨盆倾斜角(T_9-spinopelvic inclination,T_9-SPi)、腰椎前凸角(lumbar lordosis,LL)、胸椎后凸角(thoracic kyphosis,TK)、矢状面轴向垂直距离(sagittal vertical axis,SVA)。结果:治疗前,2组患者的腰痛VAS评分比较,差异无统计学意义[(4.8±0.9)分,(4.4±0.9)分,t=1.579,P=0.123];脑力劳动组的HAMA评分高于体力劳动组[(13.0±5.1)分,(9.8±3.4)分,t=2.289,P=0.030]。口服美洛昔康片2周后,脑力劳动组有效13例、无效5例,体力劳动组有效18例、无效3例,2组患者的临床疗效比较差异无统计学意义(χ~2=1.082,P=0.298)。脑力劳动组5例有腰椎骨赘、体力劳动组18例有腰椎骨赘,脑力劳动组的腰椎骨赘发生率低于体力劳动组(χ~2=13.447,P=0.000)。2组患者PI、PT、SS、TLJ、T_1-SPi、LL、SVA比较,组间差异均无统计学意义[47.6°±11.3°,51.7°±8.5°,t=-1.303,P=0.201;15.3°±10.7°,17.7°±7.9°,t=-0.778,P=0.441;32.2°±6.8°,34.0°±8.5°,t=-0.722,P=0.475;6.8°±5.4°,10.3°±9.2°,t=-1.439,P=0.159;-2.0°±3.0°,-3.5°±3.7°,t=1.387,P=0.174;-34.1°±22.4°,-28.3°±42.5°,t=-0.538,P=0.595;(33.0±28.1)mm,(19.7±36.6)mm,t=1.265,P=0.214];脑力劳动组的T_9-SPi大于体力劳动组(-6.3°±4.0°,-10.2°±4.5°,t=2.819,P=0.008),TK小于体力劳动组(23.5°±10.5°,31.5°±6.8°,t=-2.854,P=0.007)。结论:慢性非特异性腰痛患者中,脑力劳动者的焦虑程度相对严重、T_9-SPi相对较大,体力劳动者容易出现腰椎骨赘、TK相对较大。
Objective:To compare the clinical and imaging characteristics of chronic nonspecific low back pain(CNLBP)between mental workers and manual workers.Methods:The medical records of 39 patients with CNLBP(11 males and 28 females)between the ages of 31 and 60(Median=48 yrs)were analyzed retrospectively.The patients consisted of 18 mental workers(mental-work group)and 21 manual workers(manual-work group).The low back pain visual analogue scale(VAS)scores and Hamilton anxiety scale(HAMA)scores measured before the treatment and the clinical curative effects evaluated after 2-week oral application of meloxicam tablets were compared between the 2 groups.The lumbar vertebrae osteophytes were observed and pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),thoracolumbar junction(TLJ),T_1-spinopelvic inclination(T_1-SPi),T_9-spinopelvic inclination(T_9-SPi),lumbar lordosis(LL),thoracic kyphosis(TK) and sagittal vertical axis(SVA)on whole spine X-ray films were measured and compared between the 2 groups.Results:There was no statistical difference in low back pain VAS scores between the 2 groups before the treatment(4.8+/-0.9 vs 4.4+/-0.9points,t = 1. 579,P = 0. 123). The HAMA scores were higher in mental-work group compared to manual-work group( 13. 0 +/-5. 1 vs9. 8 +/-3. 4 points,t = 2. 289,P = 0. 030). After 2-week oral application of meloxicam tablets,13 patients got a good therapeutic result and 5 patients got a poor therapeutic result in mental-work group,while 18 patients got a good therapeutic result and 3 patients got a poor therapeutic result in manual-work group. There was no statistical difference in clinical curative effects between the 2 groups( χ2= 1. 082,P = 0. 298). The lumbar vertebrae osteophytes were found in mental-work group( 5) and manual-work group( 18). The incidence rates of lumbar vertebrae osteophytes were lower in mental-work group compared to manual-work group( χ~2= 13. 447,P = 0. 000). There was no statistical difference in PI,PT,SS,TLJ,T1-SPi,LL and SVA between the 2 groups( 47. 6 +/-11. 3 vs 51. 7 +/-8. 5 degrees,t =-1. 303,P = 0. 201; 15. 3 +/-10. 7 vs 17. 7 +/-7. 9 degrees,t =-0. 778,P = 0. 441; 32. 2 +/-6. 8 vs 34. 0 +/-8. 5 degrees,t =-0. 722,P =0. 475; 6. 8 +/-5. 4 vs 10. 3 +/-9. 2 degrees,t =-1. 439,P = 0. 159;-2. 0 +/-3. 0 vs-3. 5 +/-3. 7 degrees,t = 1. 387,P = 0. 174;-34. 1 +/-22. 4 vs-28. 3 +/-42. 5 degrees,t =-0. 538,P = 0. 595; 33. 0 +/-28. 1 vs 19. 7 +/-36. 6 mm,t = 1. 265,P = 0. 214). The T9-SPis were larger and the TKs were smaller in mental-work group compared to manual-work group(-6. 3 +/-4. 0 vs-10. 2 +/-4. 5 degrees,t = 2. 819,P = 0. 008; 23. 5 +/-10. 5 vs 31. 5 +/-6. 8 degrees,t =-2. 854,P = 0. 007). Conclusion: For patients with CNLBP,more severe anxiety and larger T9-SPi can be found in mental workers,while more lumbar vertebrae osteophytes and larger TK can be found in manual workers.
Objective:To compare the clinical and imaging characteristics of chronic nonspecific low back pain(CNLBP)between mental workers and manual workers.Methods:The medical records of 39 patients with CNLBP(11 males and 28 females)between the ages of 31 and 60(Median=48 yrs)were analyzed retrospectively.The patients consisted of 18 mental workers(mental-work group)and 21 manual workers(manual-work group).The low back pain visual analogue scale(VAS)scores and Hamilton anxiety scale(HAMA)scores measured before the treatment and the clinical curative effects evaluated after 2-week oral application of meloxicam tablets were compared between the 2 groups.The lumbar vertebrae osteophytes were observed and pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),thoracolumbar junction(TLJ),T_1-spinopelvic inclination(T_1-SPi),T_9-spinopelvic inclination(T_9-SPi),lumbar lordosis(LL),thoracic kyphosis(TK) and sagittal vertical axis(SVA)on whole spine X-ray films were measured and compared between the 2 groups.Results:There was no statistical difference in low back pain VAS scores between the 2 groups before the treatment(4.8+/-0.9 vs 4.4+/-0.9points,t = 1. 579,P = 0. 123). The HAMA scores were higher in mental-work group compared to manual-work group( 13. 0 +/-5. 1 vs9. 8 +/-3. 4 points,t = 2. 289,P = 0. 030). After 2-week oral application of meloxicam tablets,13 patients got a good therapeutic result and 5 patients got a poor therapeutic result in mental-work group,while 18 patients got a good therapeutic result and 3 patients got a poor therapeutic result in manual-work group. There was no statistical difference in clinical curative effects between the 2 groups( χ2= 1. 082,P = 0. 298). The lumbar vertebrae osteophytes were found in mental-work group( 5) and manual-work group( 18). The incidence rates of lumbar vertebrae osteophytes were lower in mental-work group compared to manual-work group( χ~2= 13. 447,P = 0. 000). There was no statistical difference in PI,PT,SS,TLJ,T1-SPi,LL and SVA between the 2 groups( 47. 6 +/-11. 3 vs 51. 7 +/-8. 5 degrees,t =-1. 303,P = 0. 201; 15. 3 +/-10. 7 vs 17. 7 +/-7. 9 degrees,t =-0. 778,P = 0. 441; 32. 2 +/-6. 8 vs 34. 0 +/-8. 5 degrees,t =-0. 722,P =0. 475; 6. 8 +/-5. 4 vs 10. 3 +/-9. 2 degrees,t =-1. 439,P = 0. 159;-2. 0 +/-3. 0 vs-3. 5 +/-3. 7 degrees,t = 1. 387,P = 0. 174;-34. 1 +/-22. 4 vs-28. 3 +/-42. 5 degrees,t =-0. 538,P = 0. 595; 33. 0 +/-28. 1 vs 19. 7 +/-36. 6 mm,t = 1. 265,P = 0. 214). The T9-SPis were larger and the TKs were smaller in mental-work group compared to manual-work group(-6. 3 +/-4. 0 vs-10. 2 +/-4. 5 degrees,t = 2. 819,P = 0. 008; 23. 5 +/-10. 5 vs 31. 5 +/-6. 8 degrees,t =-2. 854,P = 0. 007). Conclusion: For patients with CNLBP,more severe anxiety and larger T9-SPi can be found in mental workers,while more lumbar vertebrae osteophytes and larger TK can be found in manual workers.
引文
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[3] 朱晓丹,李琰华,李俊伟.以腰痛为表现的未分化疾病的基层临床路径[J].中国全科医学,2019,22(1):117-122.
[4] 梁丽谊,黎建颜.追风透骨胶囊联合玉龙散外敷治疗腰痛的疗效观察[J].今日药学,2016,26(7):509-511.
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[6] 张珊珊,王楚怀.腰痛的生物力学基础及临床应用分析[J].中国疼痛医学杂志,2017,23(8):602-607.
[7] 夏群,梁威.椎间盘源性腰痛的诊治进展[J].天津医药,2015,43(11):1244-1249.
[8] 高明月,朱立国,荣光,等.传统中医“骨歪”认识溯源及其对非特异性腰痛潜在发病原因启示[J].辽宁中医药大学学报,2018,20(10):130-133.
[9] 孙卓然,李危石,陈仲强,等.正常国人脊柱-骨盆矢状位序列拟合关系研究[J].中国脊柱脊髓杂志,2015,25(1):1-5.
[10] 张砚卓,王倩倩,袁越,等.中国45岁以上人群腰痛患病率调查:基于中国健康与养老追踪调查数据[J].骨科临床与研究杂志,2018,3(1):38-42.
[11] 王琳珏,石陨,石光.基于德尔菲法研究慢性腰痛的致病危险因素[J].河北中医,2017,39(8):1154-1156.
[12] 陈仲强,刘忠军,党耕町.脊柱外科学[M].北京:人民卫生出版社,2013:645-648.
[13] 王晓丽,叶翔尔.俯卧位五步摆臀康复训练法治疗慢性非特异性腰痛[J].中医正骨,2017,29(3):38-39.
[14] 徐大星,曾玲玲,梁媚.脊柱定点旋转复位法配合密集型银质针导热疗法治疗慢性非特异性腰痛[J].中医正骨,2018,30(9):78-80.
[15] 陈小珍,唐萌芽,倪慧英,等.综合疗法治疗盘源性腰痛的临床疗效观察[J].中医正骨,2014,26(5):46-48.
[16] 中国康复医学会脊柱脊髓专业委员会专家组.中国急/慢性非特异性腰背痛诊疗专家共识[J].中国脊柱脊髓杂志,2016,26(12):1134-1138.
[17] 郝伟,陆林.精神病学[M].8版.北京:人民卫生出版社,2018:45-48.
[18] 郑毓,张天宏,KEELEY J,等.ICD-11精神与行为障碍(草案)关于人格障碍诊断标准的进展[J].中华精神科杂志,2018,51(1):5-8.
[19] 刘文红,石晓明,于君,等.运动疗法对海勤人员慢性下腰痛的防治研究[J].解放军医药杂志,2018,30(11):10-13.
[20] 张建民.浅谈60例第三腰椎横突综合征的按摩治疗[J].中医临床研究,2018,10(29):94-95.
[21] 邱亚楠.手三针三穴合用治疗急性腰扭伤临床疗效观察[J].中日友好医院学报,2018,32(5):311-312.
[22] ASGEIRSDOTTIR T L,BIRGISDOTTIR K H,óLAFSDóTTIR T,et al.A compensating income variation approach to valuing 34 health conditions in Iceland[J].Econ Hum Biol,2017,27(Pt A):167-183.
[23] 黄竞威,常旭升,蔡恒,等.浅析王琦教授运用补肾健骨法双管齐下治疗腰痛临床经验[J].四川中医,2018,36(9):3-5.
[24] 傅涛,刘智强,赵林梁,等.体育类男大学生慢性非特异性下腰痛体疗康复效果分析[J].中国学校卫生,2018,39(8):1216-1219.
[25] MATSUDAIRA K,KAWAGUCHI M,ISOMURA T,et al.Assessment of psychosocial risk factors for the development of non-specific chronic disabling low back pain in Japanese workers-findings from the Japan Epidemiological Research of Occupation-related Back Pain(JOB)study[J].Ind Health,2015,53(4):368-377.
[26] BEAN D J,JOHNSON M H,KYDD R R,et al.Relationships between psychological factors,pain,and disability in complex regional pain syndrome and low back pain[J].Clin J Pain,2014,30(8):647-653.
[2] HOFMANN F,ST?SSEL U,MICHAELIS M,et al.Low back pain and lumbago-sciatica in nurses and a reference group of clerks:results of a comparative prevalence study in Germany[J].Int Arch Occup Environ Health,2002,75(7):484-490.
[3] 朱晓丹,李琰华,李俊伟.以腰痛为表现的未分化疾病的基层临床路径[J].中国全科医学,2019,22(1):117-122.
[4] 梁丽谊,黎建颜.追风透骨胶囊联合玉龙散外敷治疗腰痛的疗效观察[J].今日药学,2016,26(7):509-511.
[5] FREBURGER J K,HOLMES G M,AGANS R P,et al.The rising prevalence of chronic low back pain[J].Arch Intern Med,2009,169(3):251-258.
[6] 张珊珊,王楚怀.腰痛的生物力学基础及临床应用分析[J].中国疼痛医学杂志,2017,23(8):602-607.
[7] 夏群,梁威.椎间盘源性腰痛的诊治进展[J].天津医药,2015,43(11):1244-1249.
[8] 高明月,朱立国,荣光,等.传统中医“骨歪”认识溯源及其对非特异性腰痛潜在发病原因启示[J].辽宁中医药大学学报,2018,20(10):130-133.
[9] 孙卓然,李危石,陈仲强,等.正常国人脊柱-骨盆矢状位序列拟合关系研究[J].中国脊柱脊髓杂志,2015,25(1):1-5.
[10] 张砚卓,王倩倩,袁越,等.中国45岁以上人群腰痛患病率调查:基于中国健康与养老追踪调查数据[J].骨科临床与研究杂志,2018,3(1):38-42.
[11] 王琳珏,石陨,石光.基于德尔菲法研究慢性腰痛的致病危险因素[J].河北中医,2017,39(8):1154-1156.
[12] 陈仲强,刘忠军,党耕町.脊柱外科学[M].北京:人民卫生出版社,2013:645-648.
[13] 王晓丽,叶翔尔.俯卧位五步摆臀康复训练法治疗慢性非特异性腰痛[J].中医正骨,2017,29(3):38-39.
[14] 徐大星,曾玲玲,梁媚.脊柱定点旋转复位法配合密集型银质针导热疗法治疗慢性非特异性腰痛[J].中医正骨,2018,30(9):78-80.
[15] 陈小珍,唐萌芽,倪慧英,等.综合疗法治疗盘源性腰痛的临床疗效观察[J].中医正骨,2014,26(5):46-48.
[16] 中国康复医学会脊柱脊髓专业委员会专家组.中国急/慢性非特异性腰背痛诊疗专家共识[J].中国脊柱脊髓杂志,2016,26(12):1134-1138.
[17] 郝伟,陆林.精神病学[M].8版.北京:人民卫生出版社,2018:45-48.
[18] 郑毓,张天宏,KEELEY J,等.ICD-11精神与行为障碍(草案)关于人格障碍诊断标准的进展[J].中华精神科杂志,2018,51(1):5-8.
[19] 刘文红,石晓明,于君,等.运动疗法对海勤人员慢性下腰痛的防治研究[J].解放军医药杂志,2018,30(11):10-13.
[20] 张建民.浅谈60例第三腰椎横突综合征的按摩治疗[J].中医临床研究,2018,10(29):94-95.
[21] 邱亚楠.手三针三穴合用治疗急性腰扭伤临床疗效观察[J].中日友好医院学报,2018,32(5):311-312.
[22] ASGEIRSDOTTIR T L,BIRGISDOTTIR K H,óLAFSDóTTIR T,et al.A compensating income variation approach to valuing 34 health conditions in Iceland[J].Econ Hum Biol,2017,27(Pt A):167-183.
[23] 黄竞威,常旭升,蔡恒,等.浅析王琦教授运用补肾健骨法双管齐下治疗腰痛临床经验[J].四川中医,2018,36(9):3-5.
[24] 傅涛,刘智强,赵林梁,等.体育类男大学生慢性非特异性下腰痛体疗康复效果分析[J].中国学校卫生,2018,39(8):1216-1219.
[25] MATSUDAIRA K,KAWAGUCHI M,ISOMURA T,et al.Assessment of psychosocial risk factors for the development of non-specific chronic disabling low back pain in Japanese workers-findings from the Japan Epidemiological Research of Occupation-related Back Pain(JOB)study[J].Ind Health,2015,53(4):368-377.
[26] BEAN D J,JOHNSON M H,KYDD R R,et al.Relationships between psychological factors,pain,and disability in complex regional pain syndrome and low back pain[J].Clin J Pain,2014,30(8):647-653.