Nordin Margareta, Carragee Eugene J, Hogg-Johnson Sheilah, Weiner Shira Schecter, Hurwitz Eric L, Peloso Paul M, Guzman Jaime, van der Velde Gabrielle, Carroll Linda J, Holm Lena W, Côté Pierre, Cassidy J David, Haldeman Scott
Department of Orthopaedics and Program of Ergonomics and Biomechanics, School of Medicine and Graduate School of Arts and Science, New York University, NY, USA.
J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S117-40. doi: 10.1016/j.jmpt.2008.11.016.
Best evidence synthesis.
To critically appraise and synthesize the literature on assessment of neck pain.
The published literature on assessment of neck pain is large and of variable quality. There have been no prior systematic reviews of this literature.
The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders conducted a critical review of the literature (published 1980-2006) on assessment tools and screening protocols for traumatic and nontraumatic neck pain.
We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain.
The scientific evidence supports screening protocols in emergency care for low-risk patients; and CT-scans for high-risk patients with blunt trauma to the neck. In nonemergency neck pain without radiculopathy, the validity of most commonly used objective tests is lacking. There is support for subjective self-report assessment in monitoring patients' course, response to treatment, and in clinical research.
最佳证据综合分析。
对有关颈部疼痛评估的文献进行严格评价和综合分析。
已发表的关于颈部疼痛评估的文献数量众多且质量参差不齐。此前尚无对该文献的系统综述。
2000 - 2010年骨与关节十年颈部疼痛及其相关疾病特别工作组对1980 - 2006年发表的有关创伤性和非创伤性颈部疼痛评估工具及筛查方案的文献进行了严格审查。
我们找到了359篇关于颈部疼痛评估的文章。经过严格审查，95篇（35%）被判定为科学上可接受。筛查方案对于在钝性颈部创伤后寻求急诊护理的警觉、低风险患者检测颈椎骨折具有较高的预测价值。在评估高风险和/或多处受伤的钝性创伤颈部患者时，计算机断层扫描（CT）在成人和老年人中比X线片具有更好的有效性。在没有严重病变的情况下，临床体格检查在排除导致神经受压的结构性病变方面比确诊更具预测性。一个例外是颈椎神经根病的手法激发试验，其具有较高的阳性预测价值。没有证据表明特定的MRI表现与颈部疼痛、颈源性头痛或挥鞭样损伤有关。没有证据支持在评估颈部疼痛时使用颈椎激发性椎间盘造影、关节突关节麻醉或内侧支阻滞。可靠且有效的自我报告问卷对于评估颈部疼痛患者的疼痛、功能、残疾和心理社会状况很有用。
科学证据支持在急诊护理中对低风险患者采用筛查方案，对颈部钝性创伤的高风险患者采用CT扫描。在无神经根病症状的非急诊颈部疼痛中，大多数常用客观检查缺乏有效性。主观自我报告评估在监测患者病程、对治疗的反应以及临床研究中得到支持。
