Sizer P S, Phelps V, Matthijs O
Texas Tech University Health Science Center, School of Allied Health, Physical Therapy Program, Lubbock, Texas 79430, USA.
Pain Pract. 2001 Sep;1(3):255-73. doi: 10.1046/j.1533-2500.2001.01027.x.
Different anatomical structures and pathophysiological functions can be responsible for lumbar pain, each producing a distinctive clinical profile. Pain can arise from the intervertebral disc, either acutely as a primary disc related disorder, or as result of the degradation associated with chronic internal disc disruption. In either case, greatest pain provocation will be associated with movements and functions in the sagittal plane. Lumbar pain can also arise from afflictions within the zygapophyseal joint mechanism, as result of synovitis or chondropathy. Either of these conditions will produce the greatest pain provocation during three-dimensional movements, due to maximal stress to either the synovium or joint cartilage. Finally, patients can experience different symptoms associated with irritation to the dural sleeve, dorsal root ganglion, or chemically irritated lumbar nerve root. Differential diagnosis of these conditions requires a thorough examination and provides information that can assist the clinician in selecting appropriate management strategies.
不同的解剖结构和病理生理功能可能导致腰痛，每种情况都会产生独特的临床特征。疼痛可能源于椎间盘，急性发作时可作为原发性椎间盘相关疾病，也可能是慢性椎间盘内部破裂相关退变的结果。在这两种情况下，最大的疼痛诱发因素都将与矢状面的运动和功能相关。腰痛也可能源于关节突关节机制内的病变，如滑膜炎或软骨病。由于滑膜或关节软骨承受最大压力，这两种情况在三维运动时都会产生最大的疼痛诱发因素。最后，患者可能会出现与硬脊膜袖、背根神经节或化学性刺激的腰神经根受刺激相关的不同症状。对这些情况进行鉴别诊断需要全面检查，并提供有助于临床医生选择合适治疗策略的信息。
