Iguchi Tetsuhiro, Kanemura Aritetsu, Kasahara Koichi, Sato Keizo, Kurihara Akira, Yoshiya Shinichi, Nishida Kotaro, Miyamoto Hiroshi, Doita Minoru
Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe 651-0053, Japan.
J Spinal Disord Tech. 2004 Aug;17(4):284-90. doi: 10.1097/01.bsd.0000102473.95064.9d.
The relationship between radiologic instability and its symptoms is controversial. Previous authors consider flexion-extension radiographs to be of little value in evaluating instability; however, the current authors consider the variation of results in evaluating radiologic instability to be the result of limitations in previous researchers' methods.
In this report, sagittal translation and angulation at the L4-L5 segment were measured in flexion-extension films in 1,090 outpatients with low back and/or leg pain using a three-landmark measuring method. The symptoms of four groups with and without 3-mm translation and with and without 10 degrees angulation were compared for all the patients and for 280 age-matched patients using a scoring system. The age-matched patients were followed up for 4.6 years.
Results showed that patients with > or = 3-mm translation had significantly lower scores, indicating a limitation in their daily activities due to pain, than patients < 3-mm translation; however, no difference was observed between the groups in terms of angulation. The group with > or = 3-mm translation and > or = 10 degrees angulation significantly demonstrated the lowest scores at both evaluations during the initial visit and follow-up. This group had been suffering from low back and/or leg pain the longest and had visited the hospital significantly more often than other groups.
In conclusion, translation of the lumbar segment has a greater influence than angulation on lumbar symptoms. The presence of both radiologic factors could be an indicator for persistence of the symptoms.
影像学不稳定与其症状之间的关系存在争议。既往作者认为屈伸位X线片在评估不稳定方面价值不大；然而，当前作者认为评估影像学不稳定时结果的差异是既往研究方法存在局限性所致。
在本报告中，采用三点测量法对1090例腰腿痛门诊患者的屈伸位片上L4-L5节段的矢状面移位和角度进行测量。使用评分系统比较了所有患者以及280例年龄匹配患者中四组分别具有和不具有3mm移位以及具有和不具有10°角度的症状情况。对年龄匹配的患者进行了4.6年的随访。
结果显示，移位≥3mm的患者得分显著低于移位<3mm的患者，表明其日常活动因疼痛而受限；然而，两组在角度方面未观察到差异。移位≥3mm且角度≥10°的组在初诊和随访时的两次评估中得分均显著最低。该组腰腿痛持续时间最长，到医院就诊的次数也显著多于其他组。
总之，腰椎节段的移位对腰椎症状的影响大于角度。两种影像学因素的存在可能是症状持续存在的一个指标。
