腰椎间盘突出症患者下腰痛、肌肉痉挛与压痛阈值之间的关系。
Relationship between low-back pain, muscle spasm and pressure pain thresholds in patients with lumbar disc herniation.
作者信息
Hirayama Jiro, Yamagata Masatsune, Ogata Satoshi, Shimizu Koh, Ikeda Yoshikazu, Takahashi Kazuhisa
机构信息
Orthopedic Surgery, Centre for Spinal Disorder and Low-Back Pain, Chiba Rosai Hospital, Ichihara-City, Chiba, Japan.
出版信息
Eur Spine J. 2006 Jan;15(1):41-7. doi: 10.1007/s00586-004-0813-2. Epub 2005 Jun 2.
It is not known whether or not muscle spasm of the back muscles presented in patients with sciatic scoliosis caused by lumbar disc herniation produces muscle pain and/or tenderness. Pressure pain thresholds (PPTs) of the lower back and low-back pain were examined in 52 patients (13 of 52 presenting sciatic scoliosis) with lumbar disc herniation who complained of radicular pain and in 15 normal subjects. PPTs were measured at five points bilaterally using an electronic pressure algometer. Low-back pain was evaluated using visual analogue scale (VAS) ratings. All patients complained of radicular leg pain and were divided into the following three groups according to the presence of and the region of low-back pain: no low-back pain group, low-back pain with no laterality group, and low-back pain dominantly on the herniation side group; the VAS rating on the side ipsilateral to the herniation side was higher than that on the contralateral side. In the normal subjects, there were no statistically significant differences between sides in mean PPTs at all sites examined. PPTs were not lower in the spasmodic side (concave side) than the convex side in patients with sciatic scoliosis. PPTs on the herniation side were significantly lower than those on the contralateral side in patients with low-back pain dominantly on the herniation side. Furthermore, the areas of low PPTs were beyond the innervation area of dorsal ramus of L5 and S1 nerve root. It was considered that not only the peripheral mechanisms but also the hyper excitability of the central nervous system might contribute in lowering PPTs of the lower back on the herniation side.
腰椎间盘突出症所致坐骨神经型脊柱侧凸患者出现的背部肌肉痉挛是否会产生肌肉疼痛和/或压痛尚不清楚。对52例主诉神经根性疼痛的腰椎间盘突出症患者(52例中有13例出现坐骨神经型脊柱侧凸)和15名正常受试者的下背部压痛阈值(PPTs)及下背痛情况进行了检查。使用电子压力痛觉计在双侧五个点测量PPTs。使用视觉模拟量表(VAS)评分评估下背痛情况。所有患者均主诉有神经根性腿痛,并根据下背痛的有无及部位分为以下三组:无下背痛组、无侧别性下背痛组和以突出侧为主的下背痛组;突出侧同侧的VAS评分高于对侧。在正常受试者中,所有检查部位的平均PPTs两侧之间无统计学显著差异。坐骨神经型脊柱侧凸患者痉挛侧(凹侧)的PPTs并不低于凸侧。以突出侧为主的下背痛患者中,突出侧的PPTs显著低于对侧。此外,低PPTs区域超出了L5和S1神经根后支的支配区域。认为不仅外周机制,而且中枢神经系统的兴奋性增高可能都有助于降低突出侧下背部的PPTs。