Claus Andrew, Hides Julie, Moseley G Lorimer, Hodges Paul
Division of Physiotherapy, The University of Queensland, Brisbane, St. Lucia, Qld 4072, Australia.
J Electromyogr Kinesiol. 2008 Aug;18(4):550-8. doi: 10.1016/j.jelekin.2006.10.011. Epub 2007 Mar 7.
Studies of lumbar intradiscal pressure (IDP) in standing and upright sitting have mostly reported higher pressures in sitting. It was assumed clinically that flexion of the lumbar spine in sitting relative to standing, caused higher IDP, disc degeneration or rupture, and low back pain. IDP indicates axial compressive load upon a non-degenerate disc, but provides little or no indication of shear, axial rotation or bending. This review is presented in two main parts. First, in vivo IDP data in standing and upright sitting for non-degenerate discs are comprehensively reviewed. As methodology, results and interpretations varied between IDP studies, in vivo studies measuring spinal shrinkage and spinal internal-fixator loads to infer axial compressive load to the discs are also reviewed. When data are considered together, it is clear that IDP is often similar in standing and sitting. Secondly, clinical assumptions related to IDP in sitting are considered in light of basic and epidemiologic studies. Current studies indicate that IDP in sitting is unlikely to pose a threat to non-degenerate discs, and sitting is no worse than standing for disc degeneration or low back pain incidence. If sitting is a greater threat for development of low back pain than standing, the mechanism is unlikely to be raised IDP.
关于站立位和直立坐位时腰椎椎间盘内压力（IDP）的研究大多报告称坐位时压力更高。临床上曾假定，相对于站立位，坐位时腰椎前屈会导致更高的IDP、椎间盘退变或破裂以及腰痛。IDP表示非退变椎间盘上的轴向压缩负荷，但对剪切力、轴向旋转或弯曲几乎没有或根本没有指示作用。本综述分为两个主要部分。首先，全面回顾非退变椎间盘在站立位和直立坐位时的体内IDP数据。由于IDP研究在方法、结果和解释方面存在差异，因此还回顾了测量脊柱收缩和脊柱内固定器负荷以推断椎间盘轴向压缩负荷的体内研究。综合考虑这些数据后，很明显站立位和坐位时的IDP通常相似。其次，根据基础研究和流行病学研究来考虑与坐位IDP相关的临床假设。目前的研究表明，坐位时的IDP不太可能对非退变椎间盘构成威胁，就椎间盘退变或腰痛发病率而言，坐位并不比站立位更糟。如果坐位比站立位对腰痛发展的威胁更大，其机制不太可能是IDP升高。
