Möller H, Sundin A, Hedlund R
Department of Orthopaedic Surgery, Karolinska University, Huddinge University Hospital, Stockholm, Sweden.
Spine (Phila Pa 1976). 2000 Mar 15;25(6):683-9; discussion 690. doi: 10.1097/00007632-200003150-00006.
A cross-sectional clinical study.
To determine whether there are specific symptoms, signs, and functional disability associated with adult spondylolisthesis.
In spite of the common occurrence of adult spondylolisthesis, the symptoms, signs, and disability associated with it have not been analyzed in a large, well-defined group of patients.
The symptoms, signs, and disability of 111 consecutive patients with adult spondylolisthesis, before randomized treatment with fusion or physiotherapy, were compared with those of 39 patients with nonspecific low back pain before lumbar fusion. The patients completed a questionnaire covering clinical history and symptoms and submitted a pain drawing. The signs were documented. Functional disability and pain were quantified by 12-function and 2-pain visual analog scales, respectively.
Sixty-two percent of the patients reported low back pain as well as sciatica, 7% sciatica only, and 31% low back pain only. Specific signs were infrequent. A positive straight leg raising test result in 12% and an L5 sensory disturbance in 13% were the most common. The symptoms were similar in patients with spondylolisthesis and chronic low back pain, but the chronic low back pain group reported more functional disability. Patients with a nonorganic pain drawing (widespread, nonspecific pain) were more often blue collar workers; were more often and longer on sick leave; and reported reduced mental condition, sexual function, functional ability, and more pain than patients with an organic pain drawing (localized, specific pain).
The clinical pattern and functional disability in adult spondylolisthesis and in low back pain of nonspecific origin are similar. Sciatica in adult spondylolisthesis is typically not associated with a positive straight leg raising test result.
一项横断面临床研究。
确定与成人腰椎滑脱相关的特定症状、体征和功能障碍。
尽管成人腰椎滑脱很常见，但尚未在一大组明确界定的患者中分析与之相关的症状、体征和功能障碍。
将111例连续的成人腰椎滑脱患者在接受融合或物理治疗随机分组前的症状、体征和功能障碍，与39例腰椎融合术前非特异性下腰痛患者的症状、体征和功能障碍进行比较。患者完成了一份涵盖临床病史和症状的问卷，并提交了一份疼痛图。记录体征。分别通过12项功能视觉模拟量表和2项疼痛视觉模拟量表对功能障碍和疼痛进行量化。
62%的患者报告有下腰痛以及坐骨神经痛，7%仅报告有坐骨神经痛，31%仅报告有下腰痛。特定体征不常见。最常见的是直腿抬高试验阳性率为12%，L5感觉障碍率为13%。腰椎滑脱患者和慢性下腰痛患者的症状相似，但慢性下腰痛组报告的功能障碍更多。与有器质性疼痛图（局部、特定疼痛）的患者相比，有非器质性疼痛图（广泛、非特异性疼痛）的患者更多是蓝领工人；病假时间更长且更频繁；并且报告心理状况、性功能、功能能力下降以及疼痛更多。
成人腰椎滑脱和非特异性下腰痛的临床模式及功能障碍相似。成人腰椎滑脱引起的坐骨神经痛通常与直腿抬高试验阳性结果无关。
