Bogduk N
Newcastle Bone and Joint Institute, University of Newcastle, Royal Newcastle Hospital, Newcastle, NSW 2300, Australia.
Baillieres Best Pract Res Clin Rheumatol. 1999 Jun;13(2):261-85. doi: 10.1053/berh.1999.0020.
Tumours, infections, aneurysms and metabolic and inflammatory diseases are rare causes of neck pain. Most cases involve neck pain of unknown origin or a whiplash-associated disorder. Neck pain is common in the general community and more common in certain occupations. The natural history is relatively benign, but some 10% of patients will suffer chronic, severe symptoms. Psychosocial factors have been refuted as risk factors; the cardinal risk factors relate to occupation. In whiplash, the severity of initial symptoms is the cardinal determinant of chronicity. History is the major factor when considering diagnosis, physical examination adding little to the diagnosis. Imaging is not indicated in the vast majority of cases. The available evidence does not support most of the physical, medical and surgical therapies currently practised. Confident reassurance is paramount and justified for acute cases. Proven options for chronic neck pain are few.
肿瘤、感染、动脉瘤以及代谢和炎症性疾病是颈部疼痛的罕见病因。大多数病例涉及病因不明的颈部疼痛或挥鞭样损伤相关疾病。颈部疼痛在普通人群中很常见，在某些职业中更为常见。其自然病程相对良性，但约10%的患者会出现慢性、严重症状。心理社会因素已被排除为风险因素；主要风险因素与职业有关。在挥鞭样损伤中，初始症状的严重程度是慢性化的主要决定因素。病史是考虑诊断时的主要因素，体格检查对诊断的帮助不大。绝大多数病例无需进行影像学检查。现有证据不支持目前实施的大多数物理、药物和手术治疗方法。对于急性病例，给予自信的安慰至关重要且合理。治疗慢性颈部疼痛的有效方法很少。
