中山大学附属第六医院康复医学科 Department of Rehabilitation Medicine The Sixth Affiliated Hospital of Sun Yat-sen University
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下背痛的病因——寻找“生物因素” The cause of LBP——looking for bio
中山大学附属第六医院康复医学科 Department of Rehabilitation Medicine The Sixth Affiliated Hospital of Sun Yat-sen University
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下背痛的病因——寻找“生物因素” The cause of LBP—looking for “bio”
Motoific 症状特异性
Neural specific 神经特异性
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下背痛的问题The problem of LBP
• 89%终生罹患率
• Lifetime prevalence 89%
• 下背痛持续时间超过两周；终生罹患率达14%
• LBP>2 weeks have a lifetime prevalence of 14%
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下背痛的分类Classification of low back pain
Flags Red or yellow 红旗征/黄旗征
Low back pain
下背痛
Central mechanism
Dominant
中枢机制主导
Non-specific LBP非特异性
Specific disorders LBP特异性
— 在无症状人群中，50%都在影像中显示了脊柱退变或椎关节僵硬 50% of asymptomatic people have imaging evidence of degeneration or spondylosis — 47%下背痛患者的MRI结果都显示正常 47% of LBP patients have normal MRI — 背痛和小关节面的MRI 结果没有联系，椎间盘退变和纤维环撕裂也没有联系 No association between back pain & MRI evidence of facet for disc degeneration & annular tears — 退行性病变和下背痛的关联性很小 Minimal association between back pain & MRI evidence of facet or disc generation — X光片显示的退变能解释3%的下背痛 3% of LBP explained by X-ray evidence of degeneration — 椎间盘突出是有力的预后指标，能降低2.5倍的风险 Disc herniation are prognostic indicator, 2.5x lower risk — 了解MRI的信息对治疗效果产生消极影响 Knowledge of MRI has negatice impact on outcome
下腰痛的评估与治疗干预
Examination and management of low back pain
王伟铭 2016-8-15
中山大学附属第六医院康复医学科 Department of Rehabilitation Medicine The Sixth Affiliated Hospital of Sun Yat-sen University
• 85%的下背痛都是非特异性的
In the medical literature 85% of chronic LBP is non-specific, no radiological basis • 脊柱成像技术不能有效预测下背痛 Spinal imaging poor predictor of presence of LBP
• 不论何种治疗，患者大多数在6周内恢复，90%可在3个月内恢复
• Most recover within 6 weeks, 90% within 3-months regardless of treatment modality
• 剩下10%会患慢性下背痛，构成其花销85%
• 10% go on to have chronic LBP & account for 85% of costs
Thirty-three studies reporting imaging findings for 3110 individuals (Brinjikji 2014 )
中山大学附属第六医院康复医学科 Department of Rehabilitation Medicine The Sixth Affiliated Hospital of Sun Yat-sen University
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概要Outline
• 下腰痛有关的循证进展
• 下腰痛评估（姿势，主动动作，功能测试，
节段测试）
• 神经组织疼痛的评估
• 下腰痛亚分类的治疗概述
• 下腰痛运动干预策略
中山大学附属第六医院康复医学科 Department of Rehabilitation Medicine The Sixth Affiliated Hospital of Sun Yat-sen University
Movement impairment 动作障碍
Control impairment 控制障碍
Neurapathic./ Neural disorders 神经疾病/神经疾 病 NPSH神经性疼痛感 觉过敏 NPCN挤压神经病变 PNS外周神经敏化
Other Eg spondylolisthesis Modic changes Discitis etc 如腰椎滑脱/间盘炎
Direction & and level
Direction etc
Acticular MT 关节手法治疗
中山大学附属第六医院康复医学科 Department of Rehabilitation Medicine The Sixth Affiliated Hospital of Sun Yat-sen University