Panjabi Manohar M
Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA.
J Electromyogr Kinesiol. 2003 Aug;13(4):371-9. doi: 10.1016/s1050-6411(03)00044-0.
Clinical instability is an important cause of low back pain. Although there is some controversy concerning its definition, it is most widely believed that the loss of normal pattern of spinal motion causes pain and/or neurologic dysfunction. The stabilizing system of the spine may be divided into three subsystems: (1) the spinal column; (2) the spinal muscles; and (3) the neural control unit. A large number of biomechanical studies of the spinal column have provided insight into the role of the various components of the spinal column in providing spinal stability. The neutral zone was found to be a more sensitive parameter than the range of motion in documenting the effects of mechanical destabilization of the spine caused by injury and restabilization of the spine by osteophyle formation, fusion or muscle stabilization. Clinical studies indicate that the application of an external fixator to the painful segment of the spine can significantly reduce the pain. Results of an in vitro simulation of the study found that it was most probably the decrease in the neutral zone, which was responsible for pain reduction. A hypothesis relating the neutral zone to pain has been presented. The spinal muscles provide significant stability to the spine as shown by both in vitro experiments and mathematical models. Concerning the role of neuromuscular control system, increased body sway has been found in patients with low back pain, indicating a less efficient muscle control system with decreased ability to provide the needed spinal stability.
临床不稳定是腰痛的一个重要原因。尽管关于其定义存在一些争议，但人们普遍认为脊柱正常运动模式的丧失会导致疼痛和/或神经功能障碍。脊柱的稳定系统可分为三个子系统：(1) 脊柱；(2) 脊柱肌肉；(3) 神经控制单元。大量关于脊柱的生物力学研究深入探讨了脊柱各组成部分在提供脊柱稳定性方面的作用。在记录损伤引起的脊柱机械性失稳以及骨赘形成、融合或肌肉稳定导致的脊柱再稳定的影响时，发现中性区比运动范围是更敏感的参数。临床研究表明，在脊柱疼痛节段应用外固定器可显著减轻疼痛。该研究的体外模拟结果发现，很可能是中性区的减小导致了疼痛减轻。提出了一个将中性区与疼痛相关联的假说。体外实验和数学模型均表明，脊柱肌肉为脊柱提供了显著的稳定性。关于神经肌肉控制系统的作用，在腰痛患者中发现身体摆动增加，这表明肌肉控制系统效率较低，提供所需脊柱稳定性的能力下降。
