成人腰椎前凸角度与下腰痛的关系★

曲峰，吴叶，史亚民，巨宝兰，陈清红

课题背景：对于治疗下腰痛是否要刻意矫正腰椎的生理前凸变化，有的学者认为这是必须的。但作者在长期的临床实践中发现并不一定如此。

临床应用性：腰椎前凸角度变化对下腰痛患者的临床症状影响并不是决定性因素；男性腰椎间盘突出患者中，下腰痛患者的腰椎前凸角度较无下腰痛者减少的趋势远较女性患者更为明显。这是一个从前人们很少关注的情况。

重要的概念：椎间盘源性下腰痛：目前较容易被大家接受的观点是：除外影像学检查神经根受压迫的慢性腰背痛，那些由椎间盘本身所致的下腰痛即为椎间盘源性下腰痛。

摘要
背景：正常的腰椎有向前的生理前凸, 对维持脊柱的生理曲线和人体平衡、姿势起着重要的作用。对于腰椎的生理前凸变化是否与下腰痛有必然的联系，尚有一些争论。
目的：分析患者腰椎前凸角度与下腰痛的关系，以期对下腰痛治疗与康复中校正腰椎前凸角度的必要性有所认识。
设计、时间及地点：分类对比观察，于2007-02/2008-01在解放军总医院第一附属医院完成。
对象：选择腰椎间盘突出症患者58例，其中48例有慢性下腰痛，10例没有慢性下腰痛。
方法：通过测量58例成年人腰椎侧位X射线片腰椎前凸的角度，对患者的年龄、性别以及是否有下腰痛等因素进行统计学分析。
主要观察指标：①患者腰椎前凸角度。②下腰痛患者与没有下腰痛者腰椎前凸角度平均值的比较。③不同性别患者腰椎前凸角度与下腰痛关系。
结果：①有下腰痛患者与没有下腰痛者腰椎前凸角度平均值差异不明显 (P > 0.05)。②腰椎前凸角度与年龄没有明显的相关性(r＝-0.04, P > 0.05)。③女性腰椎前凸角度较男性大（P < 0.01）；女性腰椎前凸角度与有或无下腰痛没有关系；男性有下腰痛者腰椎前凸角度趋向于减少，但没有明显的统计学意义。
结论：成年人腰椎前凸角度的变化与下腰痛患者临床症状之间没有必然联系，治疗方案中校正生理前凸变化并不是必要的。
关键词：腰椎；前凸角度；下腰痛；性别；组织构建

曲峰，吴叶，史亚民，巨宝兰，陈清红. 成人腰椎前凸角度与下腰痛的关系[J].中国组织工程研究与临床康复，2008，12(15):2851-2853 [www.zglckf.com/zglckf/ejournal/upfiles/08-15/15k-2851(ps).pdf]

解放军总医院第一附属医院骨三科，北京市
100037

曲峰★，男，1980年生，山西省五台县人，汉族，解放军军医进修学院在读硕士，医师，主要从事脊柱外科研究。
skysunsea@
sohu.com

中图分类号:R681.533
文献标识码:B
文章编号:1673-8225
(2008)15-02851-03

收稿日期：2008-03-06 修回日期：2008-03-29 (54200803050020/W·Q)

BACKGROUND: There is lumbar lordosis in normal lumbar vertebra. It is important to maintain the physiology curve of the spine and balance of body. There are some arguments for the relation of changes in angle of lumbar lordosis and low back pain.
OBJECTIVE: To investigate the correlation between lumbar lordosis and low back pain, and to know the necessity of rectifying angle of lumbar lordosis in treatment and rehabilitation of low back pain.
DESIGN, TIME AND SETTING: A classified control observation was performed at the First Affiliated Hospital of General Hospital of Chinese PLA from February 2007 to January 2008.
PARTICIPANTS: A total of 58 patients with lumbar intervertebral disc protrusion (LIDP) were selected. There were 48 patients with chronic low back pain and 10 volunteers without lower back pain.
METHODS: We measured the lordosis angles in 48 patients with low back pain and 10 volunteers without lower back pain. Age, sex and whether developing lower back pain were statistically analyzed.
MAIN OUTCOME MEASURES: ①angle of lumbar lordosis, ②comparison of average value of lumbar lordosis's angle between low back pain patients and normal control, ③correlation of lumbar lordosis 's angle and low back pain in patients of either gender.
RESULTS: ①There was no significant difference in mean value of lumbar lordosis's angle between lower back pain patients and normal control (P > 0.05). ②There was no significant difference between lumbar lordosis's angle and age (r＝-0.04, P > 0.05). ③The angle was bigger in women than in men (P < 0.01). No difference was detected in the angle of lumbar lordosis among women with or without low back pain. Men with low back pain tended to have a less prominent lordosis, but this difference did not reach statistical significance.
CONCLUSION: Changes in the angle of lumbar lordosis have very weak correlatin to low back pain. It is unnecessary to rectify the angle of lumbar lordosis in treatment and rehabilitation of low back pain.

Qu F, Wu Y, Shi YM, Ju BL, Chen QH. Correlation of adult lumbar lordosis angle to low back pain.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(15):2851-2853(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-15/15k-2851(ps).pdf]

Third Department of Orthopaedics, First Affiliated Hospital of General Hospital of Chinese PLA, Beijing 100037, China

Qu Feng★, Studying for master's degree, Physician, Third Department of Orthopaedics, First Affiliated Hospital of General Hospital of Chinese PLA, Beijing 100037, China
skysunsea@sohu.com

Received: 2008-03-06
Accepted: 2008-03-29